Comparative results of various principles of staged hybrid myocardial revascularization in patients with preliminary coronary artery stenting and percutaneous coronary intervention after coronary bypass graft

Background: Staged hybrid coronary revascularization (HCR) is an effective treatment method for patients with CAD. At the moment, the optimal procedure for performing the surgical and endovascular stages of intervention within the framework of HCR in patients with atherosclerotic lesions of the coronary artery (CA) has not been determined. Purpose: To compare the immediate and long-term results of staged HCR in the scope of coronary artery bypass grafting (CABG) with previous CA stenting and PCI followed by CABG. Methods: On a retrospective basis, the study included 97 patients with CAD who underwent staged HCR at the Pirogov Center (Moscow, Russia) from 2014 to 2020. In group I, 48 patients underwent CABG followed by PCI (CABG+PCI); in group II, 49 patients first underwent coronary artery stenting, then CABG (PCI+CABG). The average time interval between the 1st and 2nd stages of breastfeeding was 87.5±10.6 days, the total observation period was 36.9±5.8 months. Results: The CABG+PCI cohort showed slightly better 3-year outcomes compared to the PCI+CABG cohort in terms of relapse of myocardial ischemia (20.1% vs. 24.5%, p = NS) and TLR (18.5% vs. 22.3 %, p = NS). The number of registered cases of VGF in patients of groups I and II was similar — 23.1% versus 24.0% (p = NS). The incidence of MI, stroke, death from all causes did not differ significantly in both groups and was 3 (6.3%), 2 (4.2%) and 3 (6.1%), and 3 (6.1%), 3 (6.3%) and 2 (4.1%) cases in cohorts I and II, respectively (p = NS). The overall proportion of MACE after 36.9±5.8 months of follow-up was 16.7% versus 16.3% in patients with CABG+PCI and PCI+CABG (p = NS). Conclusion: The approach to HCR with CABG performed as the first stage before PCI shows slightly greater effectiveness and provides similar safety compared to the “PCI before CABG” strategy.