title: Comparison of 30-day outcomes of coronary artery bypass grafting surgery verus hybrid coronary revascularization stratified by SYNTAX and euroSCORE.
abstract: OBJECTIVE
  The optimal treatment of multivessel coronary artery disease is not well established. Hybrid coronary revascularization by combining the left internal mammary artery-left anterior descending artery graft and drug-eluting stents in non-left anterior descending artery territories might offer superior results compared with sole coronary artery bypass grafting or sole percutaneous coronary intervention.
  
  
  METHODS
  We retrospectively analyzed the 30-day outcomes of 381 consecutive patients undergoing coronary artery bypass grafting (n = 301) vs hybrid coronary revascularization (n = 80). In a 2 × 2 matrix, the 2 groups were stratified by the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (≤32 vs ≥33) and the European System for Cardiac Operative Risk Evaluation (euroSCORE) (<5 vs ≥5). The composite endpoint (death from any cause, stroke, myocardial infarction, low cardiac output syndrome) and secondary endpoints (worsening postprocedural renal function and bleeding) were determined.
  
  
  RESULTS
  After stratification using the SYNTAX and the euroSCORE, the preoperative characteristics were similar within the 4 groups, except for the ≥33 SYNTAX/>5 euroSCORE. The hybrid coronary revascularization patients were older (77 vs 65 years, P = .001). The postoperative outcomes using combined SYNTAX and the euroSCORE stratification showed a similar rate of the composite endpoint for all groups except for patients with ≥33 SYNTAX/>5 euroSCORE (0% for the coronary artery bypass grafting group vs 33% for the hybrid coronary revascularization group, P = .001). An analysis of the secondary endpoint showed similar results across all groups, except for in the ≥33 SYNTAX/>5 euroSCORE group, in which bleeding (re-exploration for bleeding and transfusion >3 packed red blood cell units per patient) was 44% in the hybrid coronary revascularization group vs 11% in the coronary artery bypass grafting group (P = .05).
  
  
  CONCLUSIONS
  Hybrid coronary revascularization is a safe alternative to coronary artery bypass grafting in many patients with multivessel coronary artery disease. However, in high-risk patients with complex coronary artery disease (≥33 SYNTAX/>5 euroSCORE), coronary artery bypass grafting is superior to hybrid coronary revascularization.
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tenn.
authors.forename: Marzia
authors.initials: M
authors.lastname: Leacche
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tenn.
authors.forename: John G
authors.initials: JG
authors.lastname: Byrne
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tenn.
authors.forename: Natalia S
authors.initials: NS
authors.lastname: Solenkova
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tenn.
authors.forename: Brendan
authors.initials: B
authors.lastname: Reagan
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tenn.
authors.forename: Tahir I
authors.initials: TI
authors.lastname: Mohamed
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tenn.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Fredi
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tenn. Electronic address: david.zhao@vanderbilt.edu.
authors.forename: David X
authors.initials: DX
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome