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

Fraz Ahmad; Alamgir Aslam Khan; Ameer Aslam; Talha Bin Sajid; Aqsa Amjad; Aamira Parveen; Shahzaib Hassan; Bilal Qammar; Rafi Ullah

doi:10.7759/cureus.70769

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

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

Authors

Fraz Ahmad¹, Alamgir Aslam Khan², Ameer Aslam³, Talha Bin Sajid⁴, Aqsa Amjad⁵, Aamira Parveen⁶, Shahzaib Hassan⁷, Bilal Qammar⁸, Rafi Ullah⁹

Affiliations

¹ Cardiology, Shalamar Hospital, Lahore, PAK.
² Internal Medicine, Shalamar Hospital, Lahore, PAK.
³ Medicine Intensive Care Unit, Sharif Medical City, Lahore, PAK.
⁴ Medicine, University of Health and Sciences, Sahiwal, PAK.
⁵ Obstetrics and Gynecology, Shalamar Hospital, Lahore, PAK.
⁶ Internal Medicine, Jinnah Hospital Lahore, Lahore, PAK.
⁷ Internal Medicine, DHQ Hospital, Dera Ghazi Khan, PAK.
⁸ Surgery, Shalamar Hospital, Lahore, PAK.
⁹ Cardiology, Lady Reading Hospital, Peshawar, PAK.

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).