title: One-year clinical and angiographic results of hybrid coronary revascularization.
abstract: OBJECTIVE
  To evaluate 1-year clinical and angiographic results after hybrid coronary revascularization (HCR) combining off-pump left internal mammary artery (LIMA) grafting through an inferior J-hemisternotomy with percutaneous coronary intervention (PCI).
  
  
  METHODS
  Prospective, single-arm clinical feasibility study including 100 consecutive patients with multivessel disease undergoing staged HCR. The primary endpoint was the major adverse cardiac and cerebrovascular event rate at 1 year. Secondary endpoints included 1-year all-cause death, stroke, myocardial infarction, repeat revascularization, and angiographic graft and stent patency.
  
  
  RESULTS
  One-year clinical follow-up data were available in all patients. The primary endpoint was met by 20 patients (20%). Individual endpoints were as follows: 1 death due to heart failure; 1 stroke, 2 procedure-related myocardial infarctions; and 1 spontaneous myocardial infarction during follow-up. A total of 16 patients underwent repeat revascularization: 5 surgical reinterventions during the index hospitalization for angiographically suspected internal mammary artery graft dysfunction, and 3 repeat PCIs. Only 1 patient had evidence of ischemia. After discharge, PCI was performed in 6 patients who had recurrent angina, and in 2 asymptomatic patients who had angiographic restenosis. At the 1-year angiographic follow-up, 87 of 89 (98%) patients had patent internal mammary artery grafts. Angiographic restenosis was present in 10 of 100 lesions treated by PCI.
  
  
  CONCLUSIONS
  Angiographically controlled HCR was associated with a high repeat revascularization rate. The 1-year 98% LIMA-graft patency rate, and low risk of death and stroke, seem promising for the long-term outcome. Non-left anterior descending coronary artery lesion revascularization remains a challenge.
authors.affiliation: Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark. Electronic address: modrau@mail1.stofanet.dk.
authors.forename: Ivy S
authors.initials: IS
authors.lastname: Modrau
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Niels R
authors.initials: NR
authors.lastname: Holm
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Mæng
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Hans E
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Evald H
authors.initials: EH
authors.lastname: Christiansen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Steen D
authors.initials: SD
authors.lastname: Kristensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jens F
authors.initials: JF
authors.lastname: Lassen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.affiliation: Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Per H
authors.initials: PH
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality; D003718:Denmark; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D056346:Sternotomy; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: coronary artery bypass grafting; coronary revascularization; hybrid coronary revascularization; percutaneous coronary intervention