Hybrid Coronary Revascularization versus Standards: The HREVS Randomized Clinical Trial

  • #AC/COR 02-O-6
  • Adult Cardiac Surgery/Coronary. SESSION-2
  • Oral

Hybrid Coronary Revascularization versus Standards: The HREVS Randomized Clinical Trial

Vladimir Ganyukov 1, Nikita Kochergin 1, Alexander Shilov 1, Wojciech Szot 2, Vadim Popov 3, Jan Scupien 2, Kirill Kozyrin 1, Roman Tarasov 1, Leonid Barbarash 1, Olga Barbarash 1, Piotr Musialek 2

State Research Institute for Complex Issues of Cardiovascular Disease, Kemerovo, Russia; Dept. of Cardiac Vascular Diseases and Dept. of Nuclear Medicine, John Paul II Hospital, Jagiellonian University, Krakow, Poland; Federal State Budgetary Institution A.V. Vishnevsky Institute of Surgery, Moscow, Russia;

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–A


Objective: To evaluate, in a randomized study, residual myocardial ischemia (RI) and clinical outcomes of multivessel coronary artery disease (MV-CAD) revascularization using different strategies.

Background: Optimal coronary revascularization (CR) method in MV-CAD continues to be debated.

Methods: Consecutive MV-CAD patients (n=155) were randomized (1:1:1) to conventional coronary artery bypass grafting (CABG) (left internal mammary artery- left anterior descending artery (LIMA-LAD) plus venous grafts) or multivessel percutaneous coronary intervention (PCI) (everolimus-eluting stents) or hybrid CR (HCR; minimally invasive direct coronary bypass (MIDCAB) LIMA-LAD plus PCI for remaining vessel/s) following Heart Team agreement on equal technical and clinical feasibility of each strategy. Single-photon emission computed tomography (SPECT) at 12 months (primary endpoint of RI; an independent predictor of long-term prognosis) was followed by control angiography.

Analysis was intention-to-treat.

Results: Study groups baseline characteristics were similar. Incomplete revascularization rate was 3.7% vs. 2.7% vs. 2.1% (p=0.71).  Hospital stay was 13.8 vs. 13.5 vs. 4.5 days (p<0.001) and sick-leave duration was 23 vs. 16 vs. 8 weeks (p<0.001) (respectively CABG, HCR and PCI). Mean RI (95%CI) was 6.7(4.6, 8.8) vs. 6.4(4.3, 8.5) vs. 7.9(5.9, 9.8) with between group differences neither exceeding non-inferiority margin (p=0.039 for meeting non-inferiority) nor statistically significant on superiority analysis (p for superiority 0.46). MACCE rate at 12 months was 12% (CABG) vs. 13.4% (HCR) vs. 13.2% (PCI) (p=0.083), including clinically-driven repeat revascularization in 2.0% vs. 1.9% vs. 5.7% (p=0.54). Target vessel/graft failure occurred in 12.0% vs. 17.3% vs. 11.3% (p=0.62). 

Conclusion: At 12 months, RI and MACCE was similar with the 3 revascularization methods. MV-CAD PCI, using 2nd generation drug-eluting stents, was associated with a shorter hospital stay and shorter sick-leave duration. Extended follow-up will determine longer-term outcomes.

(Hybrid REvascularization Versus Standards, HREVS, NCT01699048)

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