Hybrid revascularisation in multivessel coronary artery disease: could a combination of CABG and PCI be the best option in selected patients?

Introduction The prognostic benefits of coronary artery bypass grafting (CABG) arise primarily from the placement of a left internal mammary artery (LIMA) onto the left anterior descending (LAD) coronary artery. In contrast, the long-term patency rates of adjunctive conduits (including vein and radial grafts) placed onto the remaining vessels are less good, with approximately half becoming occluded within 10 years. Continuing improvements in stent technology have made it possible to treat increasingly complex disease with percutaneous coronary intervention (PCI) and the long-term outcome rates with new-generation drug-eluting stents (DES) have improved significantly. Rather than considering each revascularisation technique in isolation, a hybrid approach utilises the potential benefits of both revascularisation techniques, and thus may improve long-term outcomes in selected patients. In this article, we will discuss the contemporary revascularisation strategies used in multivessel disease, review the available data for hybrid revascularisation and consider the need for a clinical trial that will provide the data most relevant to current practice.