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



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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





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