title: Hybrid revascularization for multivessel coronary artery disease.
abstract: OBJECTIVE
  The aim of this study was to assess the feasibility of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD) referred for standard coronary artery bypass grafting (CABG).
  
  
  BACKGROUND
  Conventional CABG is still the treatment of choice in patients with MVCAD. However, the limitations of standard CABG and the unsatisfactory long-term patency of saphenous grafts are commonly known.
  
  
  METHODS
  A total of 200 patients with MVCAD involving the left anterior descending artery (LAD) and a critical (>70%) lesion in at least 1 major epicardial vessel (except the LAD) amenable to both PCI and CABG and referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG (in a 1:1 ratio). The primary endpoint was the evaluation of the safety of HCR. The feasibility was defined by the percent of patients with a complete HCR procedure and the percent of patients with conversions to standard CABG. The occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeated revascularization, and major bleeding within the 12-month period after randomization was also assessed.
  
  
  RESULTS
  Most of the pre-procedural characteristics were similar in the 2 groups. Of the patients in the hybrid group, 93.9% had complete HCR and 6.1% patients were converted to standard CABG. At 12 months, the rates of death (2.0% vs. 2.9 %, p = NS), myocardial infarction (6.1% vs. 3.9%, p = NS), major bleeding (2% vs. 2%, p = NS), and repeat revascularization (2% vs. 0%, p = NS) were similar in the 2 groups. In both groups, no cerebrovascular incidents were observed.
  
  
  CONCLUSIONS
  HCR is feasible in select patients with MVCAD referred for conventional CABG. (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease [POL-MIDES]; NCT01035567).
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Michael Oscar
authors.initials: MO
authors.lastname: Zembala
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland. Electronic address: mateusztajstra@wp.pl.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Tajstra
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Filipiak
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hrapkowicz
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Hawranek
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010865:Pilot Projects; D011044:Poland; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: CABG; PCI; hybrid revascularization; multivessel coronary artery disease