Comparative Results of Standard Coronary Artery Bypass Grafting, Staged Hybrid Myocardial Revascularization and Purely Endovascular Correction in Patients with Coronary Artery Disease in Long-Term Period after Surgery

INTRODUCTION: Coronary artery disease (CAD) currently remains the leading cause of morbidity and mortality in Russia and in the world. In 2022, the overall morbidity with CAD among the adult population of Russia was 6517.9 per 100 thousand populations. The main surgical methods of treatment for CAD are coronary artery bypass grafting (CABG) and stenting of the coronary arteries. In some cases, a single-step complete revascularization is not possible, and one of solutions is a hybrid approach.

AIM: To compare 5-year results of CABG, staged hybrid myocardial revascularization and isolated endovascular intervention in patients with CAD and multi-vessel lesion of the coronary arteries.

MATERIALS AND METHODS: The prospective study included 330 patients with CAD and multi-vessel atherosclerotic lesion of the coronary arteries, who underwent planned myocardial revascularization in 2010–2018. Group 1 included 110 patients who underwent CABG, group 2 — 110 patients who underwent staged hybrid myocardial revascularization, group 3 included 110 patients after percutaneous coronary intervention. In 5-year follow-up period, clinical and instrumental data were evaluated, complications, lethal outcomes and re-interventions were considered.

RESULTS: In the immediate period after the surgical intervention, frequency of cardiovascular complications and residual myocardial ischemia was expectedly low in all the groups (р > 0.05). At 1 year of follow-up, cardiovascular complications were less common in group 2 (17.3%) compared to group 1 (29.1%, p = 0.038), while in group 3, adverse events were also noted in 27.3% of cases, however, the differences were not significant (p = 0.075). At 5 years, the frequency of cardiovascular complications prevailed in patients of group 1 (80.0%) compared to group 2 (57.3%) and group 3 (67.3%, p = 0.001–0.032). At the end of follow-up, the frequency of repeat revascularization was significantly higher in group 1 (41.8%) compared to group 2 (29.1%, p = 0.049). The number of such cases in group 3 (33.6%) was less than in group 1, however, the differences were not statistically significant (p = 0.125).

CONCLUSION: Isolated CABG demonstrates a higher frequency of repeat endovascular interventions at 5 years after surgery compared to hybrid revascularization that also provides better results in terms of preventing cardiovascular complications.