A post hoc analysis of prospectively collected data was performed in 440 consecutive patients undergoing RA-MIDCAB in the Netherlands between January 2016 and December 2020. Three cardiac centers performed RA-MIDCAB during that time frame: the University Medical Center Utrecht, Maastricht University Medical Center, and Isala Zwolle. All patients underwent RA-MIDCAB with the LITA-LAD conduit. In addition, a proportion of patients underwent HCR in a separate stage for PCI of non-LAD vessels. The procedure was qualified as HCR if this revascularization strategy was the documented treatment intention during the heart team meeting. Separate designations were introduced to distinguish the treatment sequences for HCR: “two-staged HCR” if a patient received RA-MIDCAB followed by PCI and “reversed two-staged HCR” if a patient received a PCI with stenting because of, for example, an emergent myocardial infarction with the culprit in either the circumflex coronary artery or the right coronary artery. To be included, patients had to be adults (>18 years) with proximal LAD lesions or chronically occluded LAD with or without additional lesions in the left circumflex artery and/or right coronary artery accessible for PCI. Patients were excluded if they had contraindications for RA-MIDCAB, such as no possibility for single-lung ventilation due to severe pulmonary disease or an intramural LAD limiting the technicality of an RA-MIDCAB procedure. Contraindications for HCR were a history of major bleeding complications due to dual antiplatelet therapy (DAPT), the latter being essential after PCI with stenting. Patient written consent and ethics approval from the Medical Ethics Review Committee at every institution performing RA-MIDCAB was acquired.