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Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients≥65 years with multivessel coronary artery disease.

Publication ,  Journal Article
Harskamp, RE; Puskas, JD; Tijssen, JG; Walker, PF; Liberman, HA; Lopes, RD; Vassiliades, TA; Peterson, ED; Halkos, ME
Published in: Am J Cardiol
July 15, 2014

Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery-to-left anterior descending coronary artery grafting with percutaneous coronary intervention of non-left anterior descending coronary arteries. The safety and efficacy of HCR in patients≥65 years of age is unknown. In this study, patients aged≥65 years were included who underwent HCR at an academic center from October 2003 to September 2013. These patients were matched 1:4 to similar patients treated with coronary artery bypass grafting (CABG) using a propensity-score matching algorithm. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between HCR and CABG, and 30-day major adverse cardiovascular and cerebrovascular events (a composite of mortality, myocardial infarction, and stroke), periprocedural complications, and 3-year all-cause mortality. Of 715 patients (143 of whom underwent HCR and 572 CABG) in the propensity score-matched cohort, rates of 30-day major adverse cardiovascular and cerebrovascular events were comparable after HCR and CABG (5.6% vs 3.8%, odds ratio 1.46, 95% confidence interval 0.65 to 3.27, p=0.36). Compared with CABG, HCR resulted in fewer procedural complications (9.1% vs 18.2%, p=0.018), fewer blood transfusions (28.0% vs 53.3%, p<0.0001), less chest tube drainage (838±484 vs 1,100±579 cm3, p<0.001), and shorter lengths of stay (<5 days: 45.5% vs 27.4%, p=0.001). Over a 3-year follow-up period, mortality rates were similar after HCR and CABG (13.2% vs 16.6%, hazard ratio 0.81, 95% confidence interval 0.46 to 1.43, p=0.47). Subgroup analyses in high-risk patients (Charlson index≥6, age≥75 years) rendered similar results. In conclusion, although the present data are limited, we found that in older patients, the use of HCR is safe, has fewer procedural complications, entails less blood product use, and results in faster recovery with similar longitudinal outcomes relative to conventional CABG.

Duke Scholars

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

July 15, 2014

Volume

114

Issue

2

Start / End Page

224 / 229

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Retrospective Studies
  • Postoperative Complications
  • Percutaneous Coronary Intervention
  • Myocardial Revascularization
  • Male
  • Incidence
  • Humans
 

Citation

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Harskamp, R. E., Puskas, J. D., Tijssen, J. G., Walker, P. F., Liberman, H. A., Lopes, R. D., … Halkos, M. E. (2014). Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients≥65 years with multivessel coronary artery disease. Am J Cardiol, 114(2), 224–229. https://doi.org/10.1016/j.amjcard.2014.04.028
Harskamp, Ralf E., John D. Puskas, Jan G. Tijssen, Patrick F. Walker, Henry A. Liberman, Renato D. Lopes, Thomas A. Vassiliades, Eric D. Peterson, and Michael E. Halkos. “Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients≥65 years with multivessel coronary artery disease.Am J Cardiol 114, no. 2 (July 15, 2014): 224–29. https://doi.org/10.1016/j.amjcard.2014.04.028.
Harskamp RE, Puskas JD, Tijssen JG, Walker PF, Liberman HA, Lopes RD, et al. Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients≥65 years with multivessel coronary artery disease. Am J Cardiol. 2014 Jul 15;114(2):224–9.
Harskamp, Ralf E., et al. “Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients≥65 years with multivessel coronary artery disease.Am J Cardiol, vol. 114, no. 2, July 2014, pp. 224–29. Pubmed, doi:10.1016/j.amjcard.2014.04.028.
Harskamp RE, Puskas JD, Tijssen JG, Walker PF, Liberman HA, Lopes RD, Vassiliades TA, Peterson ED, Halkos ME. Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients≥65 years with multivessel coronary artery disease. Am J Cardiol. 2014 Jul 15;114(2):224–229.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

July 15, 2014

Volume

114

Issue

2

Start / End Page

224 / 229

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Retrospective Studies
  • Postoperative Complications
  • Percutaneous Coronary Intervention
  • Myocardial Revascularization
  • Male
  • Incidence
  • Humans