Hybrid coronary revascularization vs. coronary artery bypass grafting in multivessel coronary artery disease

Abstract Background Hybrid coronary revascularization (HCR) is a combined surgical and percutaneous treatment for multivessel disease. However, limited data are available comparing HCR with conventional coronary artery bypass grafting (CABG). Purpose This study aimed to compare clinical outcomes between HCR and CABG in patients with multivessel disease. Methods This retrospective, single-center study included 1,924 consecutive patients with multivessel disease treated between November 2000 and December 2024. A total of 263 underwent HCR, while 1,661 patients had CABG, performed by the same surgical team. Inverse probability weighting (IPW) models were used to assess the differences in outcomes between the two groups. The balance of covariates in unweighted and weighted data was evaluated, and a standardize difference 10% was used to determine statistical significance. The primary endpoint was the occurrence of major adverse cardiovascular (MACE) defined as all-cause death, myocardial infarction, and any revascularization. Results The mean age was 68 ± 9.6 years, 83.3% were male, 32.3% had diabetes and 63.4% had three vessel disease. The median follow-up duration for the entire population was 4.4 years. After adjustment, there was no difference in MACE between HCR and CABG (OR 1.19; 95% CI 0.81–1.76; P = 0.373). No significant difference was observed in all-cause mortality (OR 0.63; 95% CI 0.36–1.10; P = 0.107). However, HCR was associated with a significantly higher incidence of myocardial infarction (OR 3.36; 95% CI 1.51–7.49; P = 0.003) and repeat revascularization (OR 3.01; 95% CI 1.85–4.90; P 0.001) compared with CABG. Regarding early post-operative outcomes, HCR was associated with a significantly lower risk for new hemodialysis (OR 0.12; 95% CI 0.02-0.88; P = 0.03) and no significant differences in new-onset atrial fibrillation, stroke, reoperation for bleeding, or 30-day mortality. Conclusion Hybrid coronary revascularization demonstrated comparable mid-term survival to CABG but was associated with a higher incidence of myocardial infarction and repeat revascularization during follow-up.