Accepted Manuscript Comparison of Hybrid Coronary Revascularization versus Coronary Artery Bypass Grafting in Patients ≥65 years with Multivessel Coronary Artery Disease Ralf E. Harskamp, MD John D. Puskas, MD, MS Jan G. Tijssen, PhD Patrick F. Walker, BS Henry A. Liberman, MD Renato D. Lopes, MD, PhD Thomas A. Vassiliades, MD, MBA Eric D. Peterson, MD, MPH Michael E. Halkos, MD, MS PII:

S0002-9149(14)01042-X

DOI:

10.1016/j.amjcard.2014.04.028

Reference:

AJC 20432

To appear in:

The American Journal of Cardiology

Received Date: 25 February 2014 Revised Date:

17 April 2014

Accepted Date: 20 April 2014

Please cite this article as: Harskamp RE, Puskas JD, Tijssen JG, Walker PF, Liberman HA, Lopes RD, Vassiliades TA, Peterson ED, Halkos ME, Comparison of Hybrid Coronary Revascularization versus Coronary Artery Bypass Grafting in Patients ≥65 years with Multivessel Coronary Artery Disease, The American Journal of Cardiology (2014), doi: 10.1016/j.amjcard.2014.04.028. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Comparison of Hybrid Coronary Revascularization

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versus Coronary Artery Bypass Grafting in Patients ≥65 years with Multivessel Coronary Artery Disease Ralf E Harskamp, MD a,b; John D. Puskas, MD, MS c; Jan G. Tijssen, PhD b; Patrick F.

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Walker, BS c; Henry A. Liberman, MD c; Renato D. Lopes, MD, PhD a; Thomas A.

a

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Vassiliades, MD, MBA c; Eric D. Peterson, MD, MPH a; Michael E. Halkos, MD, MS c

Duke Clinical Research Institute, Durham NC; b Academic Medical Center – University of

Amsterdam, The Netherlands; c Divisions of Cardiothoracic Surgery and Cardiology, Clinical

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Research Unit, Emory University School of Medicine, Atlanta GA.

Running head: Hybrid revascularization in patients ≥65 years Financial or grant support for this manuscript: none

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Corresponding author: Ralf E Harskamp, MD

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Duke Clinical Research Institute 2400 Pratt Street, Room 7047B; Durham, NC 27705 Phone: 919-668-8287; Fax: 919-668-7056; Email: [email protected]

ACCEPTED MANUSCRIPT

Abstract Hybrid coronary revascularization (HCR) combines minimally invasive LIMA-to-LAD grafting with PCI of non-LAD arteries. The safety and efficacy of HCR among patients

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≥65 years of age is unknown. In this study patients of age ≥65 were included who

underwent HCR at a U.S. academic center between October 2003 and September 2013. These patients were matched 1:4 to similar patients treated with CABG using a

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propensity-score matching algorithm. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between HCR and

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CABG, and 30-day MACCE (a composite of mortality, myocardial infarction (MI) and stroke), peri-procedural complications, and 3-year all-cause mortality. Of 715 patients (HCR=143, CABG=572) in the propensity-score matched cohort, the 30-day MACCE were comparable after HCR and CABG (5.6% vs. 3.8%, odds ratio: 1.46, 95%-CI:0.65-

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3.27, p=0.36). Compared with CABG, HCR resulted in fewer procedural complications (9.1% vs. 18.2%, p=0.018), fewer blood transfusions (28.0% vs. 53.3%, p