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

This CARE-compliant clinical case report presents the management of an 87-year-old patient with non-ST elevation myocardial infarction (NSTEMI) and complex multivessel coronary artery disease in the context of high operative risk. The patient had multiple comorbidities, including diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease, with elevated surgical risk scores (STS 6.6%, EuroSCORE II 8.6%). Coronary angiography revealed critical two-vessel disease involving the left anterior descending artery (LAD) and right coronary artery (RCA). Following multidisciplinary Heart Team evaluation, a staged hybrid coronary revascularization (HCR) strategy was selected. The first stage consisted of minimally invasive direct coronary artery bypass (MIDCAB) using a left internal mammary artery (LIMA) graft to the LAD and diagonal branch. The second stage involved percutaneous coronary intervention (PCI) with drug-eluting stent implantation in the RCA. Both procedures were successfully completed without complications. The patient demonstrated rapid recovery and was discharged on postoperative day five. Early outcomes confirmed complete revascularization and favorable clinical stability. This case highlights the clinical value of hybrid coronary revascularization as a tailored strategy in high-risk elderly patients, combining the durability of surgical grafting with the minimally invasive benefits of PCI. The report emphasizes the importance of individualized, Heart Team–guided decision-making in complex cardiovascular cases.