Hybrid coronary revascularization vs. PCI in high-risk multivessel coronary artery disease: a two-center, two-year utcome comparison.

Background: Treatment strategies for multivessel coronary artery disease (MV-CAD) include percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and the increasingly adopted hybrid coronary revascularization (HCR). HCR combines minimally invasive left internal mammary artery (LIMA)-to-left anterior descending (LAD) grafting with PCI of non-LAD lesions. However, comparative evidence in high-risk MV-CAD remains limited. Methods: We retrospectively analyzed 330 high-risk MV-CAD patients from two centers (HCR n = 109; PCI n = 221) over 2 years. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE: all-cause death, stroke, myocardial infarction, repeat revascularization, and angina). Kaplan-Meier survival analysis and conventional statistical tests were applied. Results: Baseline demographics and SYNTAX scores were similar between groups. HCR involved fewer and shorter stents than PCI. Hospital stay, ICU duration, and total costs were higher with HCR. At 2 years, angina (5.5% vs. 17.2%; P = 0.003) and MACCE (12.8% vs. 23.5%; P = 0.02) were lower with HCR; overall survival by Kaplan-Meier favored HCR (log-rank P = 0.0006). Conclusions: Despite longer hospitalization and higher costs, HCR was associated with superior long-term symptom relief and lower MACCE compared with PCI in high-risk MV-CAD. These findings support HCR as a viable strategy in carefully selected patients and warrant validation in prospective multicenter studies.