Consideration of Native Coronary Disease Progression in the Decision to Perform Hybrid Coronary Revascularization

One of the emerging revascularization strategies for advanced coronary artery disease (CAD) is hybrid coronary revascularization (HCR), which aims to maximize some of the advantages of coronary artery bypass graft surgery (CABG) and of percutaneous coronary intervention (PCI). Hybrid coronary revascularization is a strategy that combines minimally invasive CABG to the left anterior descending artery (LAD) using the left internal thoracic artery, with PCI using drug-eluting stents (DES) to the other coronary distributions, as clinically necessary. However, although the results of newer generation stents are excellent with regard to in-stent restenosis and stent thrombosis, data reveal that native CAD may be exacerbated by coronary stenting and that this phenomenon is most prevalent in patients with multivessel coronary disease. Although this native coronary disease progression (NCDP) also occurs in vessels that received saphenous vein grafts, the distal target vessel location better protects against recurrent ischemia, because the quasitotality of new lesions develops proximal to the anastomotic site. Native coronary disease progression is of vital importance in the symptoms of patients; however, there is no literature reflecting the potential interaction between HCR and NCDP. In this review, we aim to highlight considerations around NCDP and whether it should affect the decision to perform HCR.