I, Vladimir Ganyukov, and Co-authors, do not have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this

I, Vladimir Ganyukov, and Co-authors, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

• I, Vladimir Ganyukov, and Co-authors, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

Today, revascularization in multivessel coronary artery disease (MV-CAD) is achieved mainly through CABG or DES-PCI

• Today, revascularization in multivessel coronary artery disease (MV-CAD) is achieved mainly through CABG or DES-PCI

• Another less-evidenced approach is hybrid coronary revascularization (HCR: LIMA-LAD graft plus DES-PCI for the remaining vessel/s)

To compare, in a randomized trial setting, the current guideline-accepted coronary revascularization (CR) strategies in MV-CAD, including the hybrid approach

• To compare, in a randomized trial setting, the current guideline-accepted coronary revascularization (CR) strategies in MV-CAD, including the hybrid approach

• thus

• HREVS (Hybrid coronary REvascularization Versus Standards) is the first randomized study to assess safety and efficacy of contemporary coronary revascularization strategies in MV-CAD

Investigator-initiated academic trial conducted jointly by high-volume interventional cardiologists and high-volume cardiac surgeons

• Investigator-initiated academic trial conducted jointly by high-volume interventional cardiologists and high-volume cardiac surgeons

• CABG, PCI and HCR arms utilize the best, routinely available techniques and devices

• Powered for the primary end-point of residual myocardial ischemia (RI) by SPECT at 12 months

Investigator-initiated academic trial conducted jointly by high-volume interventional cardiologists and high-volume cardiac surgeons

• Investigator-initiated academic trial conducted jointly by high-volume interventional cardiologists and high-volume cardiac surgeons

• CABG, PCI and HCR arms utilize the best, routinely available techniques and devices

• Powered for the primary end-point of residual myocardial ischemia (RI) by SPECT at 12 months

MV-CAD involving LAD

• MV-CAD involving LAD

• ≥70% DS (QCA) or
• 50 - 69% with FFR ≤0.80 or SPECT evidence of regional ischemia

• Clinical and anatomic feasibility of CABG, PCI and HCR as agreed to by the local Heart Team

• Informed consent to random treatment allocation

Any prior CABG or PCI

• Any prior CABG or PCI

• Left main coronary artery stenosis

• Chronic total occlusion(s)

• Cardiac surgery other than CABG

• Circumstances precluding equal feasibility of the three CR strategies

At 12 months, residual myocardial ischemia and MACCE were similar across the three study arms (CABG, HCR, PCI)

• At 12 months, residual myocardial ischemia and MACCE were similar across the three study arms (CABG, HCR, PCI)

• PCI (2nd generation DES) showed the shortest hospital stay and sick-leave duration

• Extended follow-up will determine longer-term outcomes

HREVS at 12 mo provides no evidence for HCR benefit(s) in patients in whom PCI, CABG, or HCR are equally feasible

• HREVS at 12 mo provides no evidence for HCR benefit(s) in patients in whom PCI, CABG, or HCR are equally feasible

• Shorter hospitalization and quicker recovery (return to work) with MV (DES) PCI may provide healthcare system benefits (longer follow-up required)

Study not powered for clinical endpoints

• Study not powered for clinical endpoints

• Average Syntax score in the HREVS study (19.4) is in the lower-intermediate range (attibutable to the protocol requirement of equal treatment feasibility with 3 modalities)

• 12-month follow-up may not be sufficient in the context of potential longer-term differences