Because most hospitals lack a hybrid operating room, staged procedures are usually performed. With the staged procedure, CABG before PCI is preferred, because this approach allows the interventional cardiologist to 1) verify the patency of the LIMA-to-LAD artery graft before attempting PCI of other vessels and 2) minimize the risk of perioperative bleeding that would occur if CABG were performed after PCI (ie, while the patient is receiving DAPT). Because minimally invasive CABG may be associated with lower graft patency rates compared with CABG performed through a midline sternotomy, it seems prudent to angio- graphically image all grafts performed through a minimally invasive approach to confirm graft patency.1118 To date, no RCTs involving hybrid coronary revascular- ization have been published. Over the past 10 years, several small, retrospective series of hybrid revascularization using minimally invasive CABG and PCI have reported low mor- tality rates (0% to 2%) and event-free survival rates of 83% to 92% at 6 to 12 months of follow-up. The few series that have compared the outcomes of hybrid coronary revascular- ization with standard CABG report similar outcomes at 30 5.12. Special Considerations In addition to patients coronary anatomy and LV function and whether they have undergone prior revascularization, clinical features such as the existence of coexisting chronic conditions might influence decision making. However, the paucity of information about special subgroups represents one of the greatest challenges in developing evidence-based guidelines applicable to large populations. As is the case for many chronic conditions, studies specifically geared toward answering clinical questions about the management of SIHD in women, older adults, and individuals with diabetes mellitus or CKD are lacking. Moreover, clinicians are often guided by misconceptions and biases that serve to deprive patients of potentially beneficial therapies. 