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. 2024 Oct 3;16(10):e70769.
doi: 10.7759/cureus.70769. eCollection 2024 Oct.

Examining the Outcomes of Hybrid Coronary Revascularization in Acute ST-Elevation Myocardial Infarction (STEMI) Patients

Fraz Ahmad  1 , Alamgir Aslam Khan  2 , Ameer Aslam  3 , Talha Bin Sajid  4 , Aqsa Amjad  5 , Aamira Parveen  6 , Shahzaib Hassan  7 , Bilal Qammar  8 , Rafi Ullah  9
Affiliations

Examining the Outcomes of Hybrid Coronary Revascularization in Acute ST-Elevation Myocardial Infarction (STEMI) Patients

Fraz Ahmad et al. Cureus. .

Abstract

Background: Acute ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular condition requiring timely intervention to restore coronary blood flow and minimize myocardial damage. While percutaneous coronary intervention (PCI) remains the gold standard, it is often insufficient for patients with complex coronary anatomy, such as multivessel disease or left main coronary artery involvement. Hybrid coronary revascularization (HCR), which combines PCI and coronary artery bypass grafting (CABG), offers a novel approach to managing these complex cases.

Objective: The primary objective of this study was to evaluate the outcomes of HCR in patients presenting with acute STEMI, particularly those with high-risk features such as multivessel disease or left main coronary artery involvement.

Methods: This prospective cohort study was conducted at Shalamar Hospital, a tertiary care center in Lahore, Pakistan. The study enrolled 342 patients diagnosed with acute STEMI between January 1, 2023, and December 31, 2023. Participants underwent HCR, consisting of PCI with drug-eluting stents and minimally invasive CABG. Key outcomes included the incidence of major adverse cardiovascular events (MACE) within one year, graft patency at six months, and overall procedural success. Data were collected through patient records and follow-up assessments, and statistical analysis was performed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.).

Results: The one-year MACE rate was 14.6%, with 6.1% of patients experiencing myocardial infarction, 4.4% requiring repeat revascularization, and 4.1% experiencing cardiac death. Graft patency at six months was 94.7%, and the overall procedural success rate was 98.2%. One-year survival was observed in 95.3% of the patients.

Conclusion: HCR is a safe and effective strategy for managing acute STEMI, particularly in patients with complex coronary anatomy. It offers a balanced approach by reducing the need for invasive procedures and improving patient outcomes. Further multicenter studies are necessary to confirm these findings and establish standardized guidelines for HCR.

Keywords: coronary artery bypass grafting (cabg); coronary stents; major adverse cardiac events (mace); percutaneous coronary intervention (pci); st-elevation myocardial infarction (stemi).

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of Shalamar Hospital issued approval 384/IRB/2023/SHL. Consent was obtained or waived by all participants involved in the study. The Institutional Review Board of Shalamar Hospital granted approval for the study titled "Examining the Outcomes of Hybrid Coronary Revascularization in Acute STEMI Patients," authored by Dr. Ameer Aslam, Dr. Fraz Ahmad, and others. The ethical approval number for this study is 384/IRB/2023/SHL. The study adheres to ethical recommendations, including obtaining informed consent, ensuring participant confidentiality, minimizing risks, and upholding the right to withdraw from the study at any time. Participants were selected fairly, and any adverse events were promptly reported and addressed. The integrity of the data was preserved, and the potential benefits of the research were carefully weighed against any associated risks. Participants were also provided with access to study results and offered any beneficial treatments following the conclusion of the study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Kaplan-Meier survival curve with MACE over 12 months
MACE: major adverse cardiovascular events
See this image and copyright information in PMC

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