Staged Hybrid Coronary Revascularization in an Octogenarian with NSTEMI and High Surgical Risk: A CARE-Compliant Case Report

Authors

DOI:

https://doi.org/10.5281/zenodo.19132069

Keywords:

case report, metabolic surgery, cardiometabolic risk, insulin resistance, obesity, sleeve gastrectomy, bariatric surgery, Type 1 diabetes mellitus

Abstract

Background:
Management of multivessel coronary artery disease (CAD) in elderly patients presenting with non-ST elevation myocardial infarction (NSTEMI) remains complex, particularly in the presence of multiple comorbidities and elevated operative risk. Contemporary guidelines recommend individualized, Heart Team–based decision-making when selecting revascularization strategies [3–5]. Hybrid coronary revascularization (HCR), combining minimally invasive surgical bypass with percutaneous coronary intervention (PCI), has emerged as a promising approach to achieve complete revascularization while minimizing procedural risk [9,10].

 

Case Presentation:

An 87-year-old man presented with NSTEMI and a history of diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease. Risk stratification demonstrated high operative risk (STS score 6.6%, EuroSCORE II 8.6%). Coronary angiography revealed critical two-vessel disease, including a severe lesion in the left anterior descending artery (LAD) involving the diagonal branch and a significant stenosis of the mid-right coronary artery (RCA). Following multidisciplinary Heart Team evaluation, a staged hybrid revascularization strategy was selected. The initial stage consisted of minimally invasive direct coronary artery bypass (MIDCAB) using a left internal mammary artery (LIMA) graft to the LAD and diagonal branch via left thoracotomy on a beating heart. Two days later, PCI with drug-eluting stent implantation was successfully performed in the right coronary artery.

 

Results:
Both procedures were completed without complications. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Early outcomes demonstrated successful complete revascularization and rapid clinical recovery.

 

Discussion:
Hybrid coronary revascularization offers a tailored strategy for high-risk elderly patients by combining the long-term durability of LIMA-to-LAD grafting with the minimally invasive nature of PCI [9–14]. In frail populations, this approach may reduce perioperative risk while maintaining the benefits of complete revascularization [18–21]. Increasing evidence supports the prognostic importance of complete revascularization in elderly patients with acute coronary syndromes [22–25].

 

Conclusion:
Staged hybrid coronary revascularization represents a safe and effective strategy for achieving complete revascularization in carefully selected high-risk elderly NSTEMI patients. A multidisciplinary Heart Team approach enables individualized decision-making and may improve short-term clinical outcomes.

 Keywords: hybrid coronary revascularization; NSTEMI; elderly; MIDCAB; percutaneous coronary intervention; Heart Team; complete revascularization

Author Biography

Giorgi Gabaidze , New Vision University, Tbilisi, Georgia

Avicenna Medical University, Batumi, Georgia; Shota Rustaveli State University, Batumi, Georgia

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Cover image for Volume 1, Issue 1 (2026) of the Georgian Medical Journal, titled “A New Voice in Georgian Medicine.” The design features a modern medical visual emphasizing clinical quality, patient safety, and evidence-based healthcare.

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Published

03/20/2026

How to Cite

Gabaidze , G., Zhvania, N., Tsintsadze , N., Chkhatrishvili , N., & Katcharava , M. (2026). Staged Hybrid Coronary Revascularization in an Octogenarian with NSTEMI and High Surgical Risk: A CARE-Compliant Case Report. Georgian Medical Journal, 1(1), 199–208. https://doi.org/10.5281/zenodo.19132069

Issue

Vol. 1 No. 1 (2026): A new voice in Georgian medicine

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Case Reports

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Copyright (c) 2026 Giorgi Gabaidze , Nino Zhvania, Nana Tsintsadze , Nia Chkhatrishvili , Mariam Katcharava

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