Off-pump coronary artery bypass grafting versus optimal medical therapy alone：effectiveness of incomplete revascularization in high risk patients

BackgroundGeriatric patients with multivessel coronary artery disease （CAD） are a challenging group to treat; these cases elicit dis-cussion within heart teams regarding the actual benefit of undertaking major surgery on these patients and often lead to abandon the surgical option. Percutaneous procedures represent an important option, but coronary anatomy may be unfavorable. Off-pump coronary artery bypass （OPCAB） provides good quality graft on left anterior descending （LAD） without exposing the patient to cardiopulmonary bypass, and might be the ideal choice in patients with multiple comorbidities, not eligible to percutaneous or on-pump procedures. The objective of this study was to compare survival during a mid-term follow-up in high-risk patients with no percutaneous alternative, either treated with OPCAB or discharged in medical therapy.MethodsWe retrospectively evaluated from June 2008 to June 2013, 83 high-risk patients with multivessel CAD were included： 42 were treated with incomplete off-pump revascularization using left internal mammary artery （LIMA） on LAD; 41 were discharged in optimal medical therapy （OMT）, having refused surgery. Follow-up ended in March 2015, with a telephonic interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events （MACEs）.ResultsDuring follow up, 11 deaths in OPCAB group and 27 deaths in OMT group occurred. Death was due to cardiac factors in 6 and 15 patients, respectively. MACEs were observed in 6 patients in OPCAB group and in 4 patients in OMT group. With regards to survival from all-cause mortality, patients who underwent OPCAB survived more than those dis-charged in OMT （Log Rank ＆lt; 0.001）, and OMT group carries a propensity score-adjusted hazard ratio of 3.862 （P ＆lt; 0.001）. With regards to survival from cardiac-related events, patients who underwent OPCAB survived more than those discharged in OMT （Log Rank = 0.002）, and OMT group carries a propensity score-adjusted hazard ratio of 3.663 （P = 0.010）. There is no statistically significant difference concerning freedom from MACEs （Log Rank = 0.273）.ConclusionsFor high-risk patients with multivessel CAD, not eligible to on-pump complete revascularization surgery or percutaneous procedures, incomplete revascularization with OPCAB LIMA-on-LAD offers benefits in survival when compared to OMT alone.

Complete revascularization reduces adverse outcomes in patients with multivessel coronary artery disease

AIM To investigate the infuence of complete and incomplete revascularization （ICR） in patients with multivessel coro-nary artery disease undergoing coronary artery bypass or percutaneous coronary intervention.METHODS We searched PubMed using the keywords “complete revascularization”, “incomplete revascularization”, “cor-onary artery bypass”, and “percutaneous coronary intervention”. We selected randomized controlled studies （RCT） and observational studies only for review. The main outcomes of interest were mortality, myocardial infarction （MI） and repeat revascularization. We identified further studies by hand searching relevant publications and included those that met with the inclusion criteria in our fnal analysis and performed a systematic review.RESULTSTen studies were identified, including 13327 patients of whom, 8053 received complete revascularization and 5274 received ICR. Relative to ICR, CR was associated with lower mortality （RR： 0.755, 95%CI： 0.66 to 0.864, P = 0.765, I2 = 0.0%）, lower rates of MI （RR： 0.759, 95%CI： 0.615 to 0.937, P = 0.091, I2 = 45.1%）, lower rates of MACCE （RR： 0.731, 95%CI： 0.668 to 0.8, P = 0.453, I2 = 0.0%） and reduced rates of repeat coronary revascularization （RR： 0.691, 95%CI： 0.541 to 0.883, P = 0.0, I2 = 88.3%）.CONCLUSIONCR is associated with lower rates of adverse outcomes. CR can be used as a standard in the choice of any particular revascularization strategy.

Clinical Outcomes in Patients Undergoing Triple-Vessel Angioplasty for Symptomatic Coronary Artery Disease

Current treatment strategies for multi-vessel coronary artery disease include either coronary artery bypass surgery or percutaneous coronary intervention with stenting. The present study evaluates the morbidity and mortality among coronary artery disease patients undergoing triple-vessel angioplasty. This prospective record based descriptive study was carried out in Medical College, Pariyaram, Kannur, Kerala;a tertiary care cardiac centre in South India. Fifty consecutive patients who underwent angioplasty of one or more lesions in each of the three major coronary arteries from May 2010 to July 2012 were included in the study. The study describes the clinical profile of the patients and a moderate term clinical follow-up to reassess the symptoms, functional status and left ventricular function by history, electrocardiogram, echocardiogram, and treadmill test. Mortality and morbidity were considered as end-points of the study. Event-free survival rate was 94% at a mean follow-up of 20 months. Overall 98% continued success was obtained with triple-vessel angioplasty. Triple-vessel angioplasty is a safe and effective therapy as an alternative to surgical revascularization in selected patients with triple-vessel coronary artery disease.

Conservative strategy for treatment of stable coronary artery disease

Patients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. In relation to the major outcomes of death and myocardial infarction, it is not clear in the literature if an invasive strategy of myocardial revascularization is superior to a conservative strategy of optimized medical therapy. Moreover, with the exception of patients with left main coronary disease, this similarity in prognosis also occurs in different subgroups of patients.

Coronary angiography in the very old: impact of diabetes on long-term revascularization and mortality

Background Diabetes is often associated with coronary artery disease,leading to adverse clinical outcomes.Real-world data is limited regarding the impact of diabetes in very old patients undergoing coronary angiography on the risk for late or repeated coronary revascularization and mortality.Methods Retrospective analysis of 1,353 consecutive patients>80 years who were admitted to the cardiac unit and further underwent coronary angiography.Subsequent revascularization procedures and all-cause mortality were recorded over a median fbllow-up of 47 months and their relation to diabetic status and presentation with acute coronary syndrome(ACS)was studied.Results Diabetes was present in 31%of the patients undergoing coronary angiography,and was associated with higher rates of obesity,hypertension,hyperlipidemia,chronic kidney disease and female gender.ACS was the presenting diagnosis in 71%of the patients and was associated with worse survival(1-year mortality 20%in ACS vs.6.2%in non-ACS patients,P<0.0001).Increase in long-term mortality rates was seen in diabetic subjects compared to non-diabetic subjects presenting with ACS(log-rank P=0.005),but not in the non-ACS setting(P=0」99).In a multivariable model,additionally adjusting for acuity of presentation,the presence of diabetes was associated with an adjusted hazard ratio of 1.60(95%confidence interval:12-2.28),P=0.011,for the need of late or repeat coronary revascularization and 1.48(1.26-1.74),P<0.0001 for all-cause mortality,during long-term follow-up.Conclusions In very old patients undergoing coronary angiography,presentation with ACS was associated with worse survival.Diabetes was an independent predictor of late or repeated revascularization and long-term mortality.

Incomplete Kawasaki disease complicated with acute abdomen: A case report

Kawasaki disease(KD)is an acute systemic vasculitis characterized by unknown etiology.CASE SUMMARY A 4.5-year-old boy developed an acute abdomen during the onset of incomplete KD.He still had persistent abdominal pain after undergoing exploratory laparotomy and appendectomy.Ultrasound examination at early onset revealed a giant coronary artery aneurysm.The patient developed a myocardial infarction and heart failure accompanied by respiratory and cardiac arrest.He underwent coronary artery revascularization and coronary artery bypass graft using an autologous internal mammary artery.After the operation,the cardiac output increased,and the symptoms of heart failure resolved.Follow-up evaluation at 1 mo after operation showed that the patient's cardiac function had restored to New York Heart Association standard Grade I heart failure,and normal growth was obtained.CONCLUSION Coronary artery revascularization and coronary artery bypass graft is an effective method for treating myocardial ischemia in children with KD complicated with giant coronary artery aneurysm.Nevertheless,some issues still need specific attention.

Risk or Beneficial Factors Associated with Unplanned Revascularization Risk Following Percutaneous Coronary Intervention: A Large Single-Center Data

Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied.Results The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%,6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio(HR) = 2.320;95% confidence interval(CI): 1.643–3.277;P < 0.001], time of procedure(HR = 1.006;95%CI: 1.001–1.010;P = 0.014), body mass index(HR = 1.104;95% CI: 1.006–1.210;P = 0.036), incomplete revascularization(ICR)(HR = 2.476;95% CI: 1.030–5.952;P = 0.043), and age(HR = 1.037;95% CI:1.000–1.075;P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux(HR = 0.618;95% CI: 0.531–0.719;P < 0.001), secondgeneration durable polymer drug-eluting stent(HR = 0.713;95% CI: 0.624–0.814;P < 0.001), left anterior descending artery involvement(HR = 0.654;95% CI: 0.530–0.807;P < 0.001), and age(HR = 0.992;95%CI: 0.985–0.998;P = 0.014), were independently associated with decreased two-year UR risk. While,Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score(HR =1.024;95% CI: 1.014–1.033;P < 0.001) and ICR(HR = 1.549;95% CI: 1.290–1.860;P < 0.001) were negatively associated with two-year UR risk.Conclusion Specific factors were positively or negatively associated with short-and medium-long-term UR following PCI.

Minimally invasive surgical techniques in the era of hybrid coronary revascularization： additional benefits for the elderly patients？

Geriatric patients affected by stable multi-vessel coronary artery disease （CAD） are at the crossroad： they can live with the risks of acute coronary syndrome, malignant arrhythmias or heart failure, or they can undergo a rapid evaluation for myocardial revascularization.

Single-territory incomplete surgical revascularization improves regional wall motion of remote ventricular areas： results from a propensity-matched study

Objective Basic science studies demonstrated a general intramyocardial angiogenetic response potentially responsible for the creation of a microvascular neocapillaries network assisting myocardial function. We hypothesized that the benefit provided by the reperfusion of left anterior descending （LAD） territories and the biological angiogenetic drive triggered by the revascularization could translate in a global improvement in ventricular contractility, not restricted to the grafted area. Methods High-risk patients with multivessel coronary artery disease and preoperative wall motion abnormalities were retrospectively analyzed to compare outcomes and regional ventricular function of those who received optimal medical therapy （OMT） versus those who underwent off-pump coronary artery bypass grafting （OPCABG） and received an incomplete myocardial revascularization using left internal mammary artery （LIMA） on LAD （OPCABG group）. From January 2007 to December 2014, 206 patients （OMT, n = 136, OPCABG, n = 70） were propensity-score matched to have 70 matched pairs. Variables included in propensity score analyses were ejection fraction （EF）, left ventricular end diastolic volume （LVEDVi）, EuroSCORE II. Primary endpoint was the variation in the global wall motion score index （AWMSI） as evaluated by transthoracic echocardiography. Follow up was completed at 3 years from surgery or hospital discharge. Results Regional analysis of ventricular function revealed a regional WMSI improvement in the OPCABG group not only for LAD territories but also for non-LAD regions, associated with a reduction in the negative left ventricular ischemic remodeling, compared to patients discharged in optimal medical therapy. Global AWMSI was negative in OPCABG group （-3.4 ± 2.8%） and positive in the OMT group （5.9 ± 3.1%）, indicating a better wall motion score for OPCAB patients. Surprisingly, regional WMSI improved also in non-grafted territories in the off-pump CABG group with a delta value of -3.7 ± 5.3% for left circumflex artery （LCX） area and -3.5 ± 5.4% for right coronary artery （RCA） area. Conclusions In patients with multivessel coronary artery disease, LIMA-to-LAD grafting is associated with an improvement in the WMSI involving also the surrounding non-LAD ungrafted segments and with the attenuation of negative global and regional ischemic ventricular remodeling.

Ventriculocoronary artery bypass(VCAB):a new approach to myocardial revascularization

Nowadays,coronary artery bypass accounts for nearly half of the deaths in the developed world and 25% in the developing world.Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) have become standard treatment for coronary artery disease.Direct revascularization from the left ventricle has already been studied in late 1960s. Recently some researchers reported a new approach to myocardial revascularization,ventriculo- coronary artery bypass (VCAB). In this paper we review the advance in experimental research and clinical research.

Impact of coronary angioplasty in elderly patients with non-ST-segment elevation myocardial infarction

Background As treatment of coronary artery disease improved over the last years,management of elder patients remained a matter of debate since this age group has been underrepresented in most trials.The study aimed to evaluate a population of patients with≥85 years old with non-ST-segment elevation myocardial infarction(NSTEMI)and compare the prognosis according to coronary revascularization execution.Methods We retrospectively studied 324 patients included in a national multicenter registry between October 2010 and October 2018,who underwent coronary angiography and had at least one stenosis≥50%.Results In this population,73.1%of the patients underwent percutaneous coronary intervention(PCI)and 26.9%of the patients underwent optimized medical treatment(OMT).The OMT group had more past history of diabetes,stroke and dementia.On coronary angiography,the PCI group used more often the femoral artery access and single-vessel lesions were also more common.Three-vessel disease was more common in the OMT group.During hospitalization,there were more major bleeding events and death in the PCI group.During the one-year follow-up,there were no significant differences in all-cause mortality rate.Conclusions Very old patients with NSTEMI submitted to OMT had more comorbidities and more three-vessel disease,factors that could have influenced the therapeutic decision.Patients undergoing PCI had more in-hospital major bleeding events and mortality,with no significant differences after one year.

Right ventricular-arterial uncoupling as an independent prognostic factor in acute heart failure with preserved ejection fraction accompanied with coronary artery disease

Background:Right ventricular(RV)-arterial uncoupling is a powerful independent predictor of prognosis in heart failure with preserved ejection fraction(HFpEF).Coronary artery disease(CAD)can contribute to the pathophysiological characteristics of HFpEF.This study aimed to evaluate the prognostic value of RV-arterial uncoupling in acute HFpEF patients with CAD.Methods:This prospective study included 250 consecutive acute HFpEF patients with CAD.Patients were divided into RV-arterial uncoupling and coupling groups by the optimal cutoff value,based on a receiver operating characteristic curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure(TAPSE/PASP).The primary endpoint was a composite of all-cause death,recurrent ischemic events,and HF hospitalizations.Results:TAPSE/PASP≤0.43 provided good accuracy in identifying patients with RV-arterial uncoupling(area under the curve,0.731;sensitivity,61.4%;and specificity,76.6%).Of the 250 patients,150 and 100 patients could be grouped into the RV-arterial coupling(TAPSE/PASP>0.43)and uncoupling(TAPSE/PASP≤0.43)groups,respectively.Revascularization strategies were slightly different between groups;the RV-arterial uncoupling group had a lower rate of complete revascularization(37.0%[37/100]vs.52.7%[79/150],P<0.001)and a higher rate of no revascularization(18.0%[18/100]vs.4.7%[7/150],P<0.001)compared to the RV-arterial coupling group.The cohort with TAPSE/PASP≤0.43 had a significantly worse prognosis than the cohort with TAPSE/PASP>0.43.Multivariate Cox analysis showed TAPSE/PASP≤0.43 as an independent associated factor for the primary endpoint,all-cause death,and recurrent HF hospitalization(hazard ratios[HR]:2.21,95%confidence interval[CI]:1.44-3.39,P<0.001;HR:3.32,95%CI:1.30-8.47,P=0.012;and HR:1.93,95%CI:1.10-3.37,P=0.021,respectively),but not for recurrent ischemic events(HR:1.48,95%CI:0.75-2.90,P=0.257).Conclusion:RV-arterial uncoupling,based on TAPSE/PASP,is independently associated with adverse outcomes in acute HFpEF patients with CAD.

Evaluation of the ischemic risk in triple-vessel artery patients undergoing stent implantation

Objective Coronary artery disease(CAD) is a global problem.Every year, there was millions of patients suffered from CAD. With the fast development of coronary revascularization therapy, the mortality has decreased dramatically, while there still some forts needed to be conquered, such as multi-vessel coronary artery disease(MVD).

Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era

Percutaneous coronary intervention with stenting is followed by a duration of dual antiplatelet therapy(DAPT)to reduce stent thrombosis and avoid target lesion failure.The period of DAPT recommended in international guidelines following drug-eluting stent implantation is 12 mo for most patients with acute coronary syndrome,and 6 mo for patients with chronic coronary syndrome or high bleeding risk.The new generation of drug-eluting stents have metallic platforms with thinner struts,associated with significantly less stent thrombosis.Shortened DAPT has been investigated with these stents,with evidence from randomised clinical trials for some individual stents showing non-inferior safety and efficacy outcomes.This has to be balanced by the effect of DAPT on secondary prevention of systemic cardiovascular disease especially in high-risk populations.This review will outline the current evidence for individual stents with regards to DAPT duration for both acute coronary syndrome and chronic coronary syndrome and discuss further directions for research and personalised medicine in this contemporary percutaneous coronary intervention era.

LDH、NT-proBNP、ALB水平对不完全性川崎病的早期诊断价值

目的:探讨乳酸脱氢酶(LDH)、N末端脑钠肽前体(NT-proBNP)、白蛋白(ALB)水平对不完全性川崎病(IKD)的早期诊断价值。方法:选取巴彦淖尔市医院2020年1月—2023年1月收治的80例IKD患儿作为IKD组,选取本院同期收治的80例典型川崎病(KD)患儿作为KD组。所有患儿入院后检测LDH、NT-proBNP、ALB水平,对比IKD组与KD组一般情况和LDH、NT-proBNP、ALB水平。通过受试者操作特征(ROC)曲线分析LDH、NT-proBNP、ALB水平对IKD的早期诊断价值。同时将80例IKD患儿依照冠脉损伤情况分为两个亚组,即无损伤组(n=30)和损伤组(n=50),对比两组LDH、NT-proBNP、ALB水平。结果:IKD组和KD组性别、年龄及高热、多形性皮疹、口腔黏膜变化占比对比,差异均无统计学意义(P>0.05);IKD组发热时间长于KD组,指端改变、结膜充血、颈部淋巴结肿大占比低于KD组,差异均有统计学意义(P<0.05);IKD组LDH、NT-proBNP、ALB水平均明显高于KD组,差异均有统计学意义(P<0.05);LDH、NT-proBNP、ALB三者联合对IKD的诊断效能优于单一检测;损伤组LDH、NT-proBNP、ALB水平均明显高于无损伤组,差异均有统计学意义(P<0.05)。结论:LDH、NT-proBNP、ALB水平对IKD的早期诊断价值较高,且临床可考虑通过LDH、NT-proBNP、ALB三者联合来诊断IKD。

Effect of metabolic syndrome on prognosis and clinical characteristics of revascularization in patients with coronary artery disease

Background People with metabolic syndrome are at higher risk for developing coronary artery disease （CAD）. The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in hospital and long term prognosis of CAD with metabolic syndrome and to determine the factors influencing the prognosis of the disease. Methods The DESIRE registry contains data of 3696 patients with CAD between 2001 and 2004. Mean long term followup was （8294±373） days. Diagnosis of metabolic syndrome was based on modified International Diabetes Federation （IDF） Worldwide Definition of the Metabolic Syndrome, using body mass index （BMI） instead of waist circumference. Results Of 2596 patients with complete records of height, weight, and so on, 1280 （49.3%） were identified with metabolic syndrome. The patients with metabolic syndrome had higher level of body mass index, systolic blood pressure, diastolic blood pressure, fasting glucose and disordered blood lipid （all P〈0.0001）, with higher creatinine [（10.5±4.3） mg/L vs （9.9±2.9） mg/L, P〈0.0001] and the number of white blood cells [（7.49±2.86）×10^9/L VS （7.19 ± 2.62） ×10^9/L, P=0.008） compared with those without metabolic syndrome. The patients with metabolic syndrome showed severer coronary angiographic alterations （left main artery and/or ≥2-vessel） （73.6% vs 69.6%, P=0.031）. There were no significant differences of major adverse cardiac and cerebral events （MACCE） or mortality in hospital between the two groups. During followup, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly （11.8% vs 10.0%, P=0.044）. Fasting blood glucose （≥ 1000 mg/L） and triglyceride （TG ≥1500 mg/L） were responsible for most of the increased risk associated with the metabolic syndrome （adjusted OR 1.465, 95% CI 1.037-1.874, P=0.032; OR 1.378, 95% CI 1.01±1.768, P=0.044）. Conclusions The prevalence of metabolic syndrome was very high in CAD patients. The metabolic syndrome confers a higher risk of long term MACCE in patients with CAD, and dysglycaemia and hypertriglycaemia appear to be responsible for most of the associated risk.

Assessing the association of appropriateness of coronary revascularization and 1-year clinical outcomes for patients with stable coronary artery disease in China

Background:The Chinese appropriate use criteria(AUC)for coronary revascularization was released in 2016 to improve the use of coronary revascularization.This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease(CAD)patients.Methods:We conducted a prospective,multi-center cohort study of stable CAD patients with coronary lesion stenosis≥50%.After the classification of appropriateness based on Chinese AUC,patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received.The primary outcome was a composite of death,myocardial infarction,stroke,repeated revascularization,and ischemic symptoms with hospital admission.Results:From August 2016 to August 2017,6085 patients were consecutively enrolled.Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events(MACCEs;hazard ratio[HR]:0.62;95%confidence interval[CI]:0.45-0.86;P=0.004)than medical therapy in patients with appropriate indications(n=1617).No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications(n=2658,HR:0.81;95%CI:0.52-1.25;P=0.338)and inappropriate indications(n=1810,HR:0.80;95%CI:0.51-1.23;P=0.308).Conclusions:In patients with appropriate indications according to Chinese AUC,coronary revascularization was associated with significantly lower risk of MACCEs at 1 year.No benefit was found in coronary revascularization in patients with inappropriate indications.Our findings provide evidence for using Chinese AUC to guide clinical decision-making.

冠状动脉内膜剥脱术近中远期预后的研究进展

弥漫性冠状动脉病变患者需要依靠冠状动脉内膜剥脱术同期行冠状动脉旁路移植术实现病变血管的完全血运重建。近年来多项研究表明,冠状动脉内膜剥脱术可改善患者冠状动脉通畅率并减少并发症。本文就不同手术方式、手术位点和靶血管数量的冠状动脉内膜剥脱术后近中远期预后的研究进展进行综述。

冠状动脉慢性完全闭塞病变侧支研究进展

在冠状动脉慢性完全闭塞(CTO)病变中,侧支的形成是特征性的表现。侧支维持着病变远端的心肌活力,对于后续的血运重建十分重要。了解侧支的病理学与病理生理学过程,有助于理解侧支的形态学与功能学评价方法,从而及时地对CTO病变进行诊断和治疗。本文拟综述CTO病变中侧支形成的病理生理学机制以及形态和功能的评估方法,论述侧支的临床意义。

Major risk-stratification models fail to predict outcomes in patients with multivessel coronary artery disease undergoing simultaneous hybrid procedure

Background The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events （MACCE） in patients with multivessel disease undergoing hybrid coronary revascularization. Methods The data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification （GRC） calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization. Results During a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power （area under curve （AUC）） of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 （95% confidence interval 0.42-0.77）, 0.65 （0.47-0.82）, 0.57 （0.39-0.75） and 0.65 （0.46-0.83）, respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 （P=0.86）, 5.39 （P=0.37）, 13.81 （P=0.32） and 0.02 （P=0.89）, respectively. Conclusions In patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.