Clinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery: a meta-analysis of 1,190 patients

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• 作者：Ralf E. Harskamp ; MD^a ; ^b ; ^{r.e.harskamp@gmail.com" class="auth_mail} ; Akshay Bagai ; MD ; MHS^c ; Michael E. Halkos ; MD ; MSc^d ; Sunil V. Rao ; MD ; MHS^a ; William B. Bachinsky ; MD^e ; Manesh R. Patel ; MD^a ; Robbert J. de Winter ; MD ; PhD^b ; Eric D. Peterson ; MD ; MPH^a ; John H. Alexander ; MD ; MHS^a ; Renato D. Lopes ; MD ; PhD ; MHS^a
• 刊名：American Heart Journal
• 出版年：April, 2014
• 年：2014
• 卷：167
• 期：4
• 页码：585-592
• 全文大小：1067 K

文摘

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Background

Hybrid coronary revascularization (HCR) represents a minimally invasive revascularization strategy in which the durability of the internal mammary artery to left anterior descending artery graft is combined with percutaneous coronary intervention to treat remaining lesions. We performed a systematic review and meta-analysis to compare clinical outcomes after HCR with conventional coronary artery bypass graft (CABG) surgery.

Methods

A comprehensive EMBASE and PUBMED search was performed for comparative studies evaluating in-hospital and 1-year death, myocardial infarction (MI), stroke, and repeat revascularization.

Results

Six observational studies (1 case control, 5 propensity adjusted) comprising 1,190 patients were included; 366 (30.8%) patients underwent HCR (185 staged and 181 concurrent), and 824 (69.2%) were treated with CABG (786 off-pump, 38 on-pump). Drug-eluting stents were used in 328 (89.6%) patients undergoing HCR. Hybrid coronary revascularization was associated with lower in-hospital need for blood transfusions, shorter length of stay, and faster return to work. No significant differences were found for the composite of death, MI, stroke, or repeat revascularization during hospitalization (odds ratio 0.63, 95% CI 0.25-1.58, P = .33) and at 1-year follow-up (odds ratio 0.49, 95% CI 0.20-1.24, P = .13). Comparisons of individual components showed no difference in all-cause mortality, MI, or stroke, but higher repeat revascularization among patients treated with HCR.

Conclusions

Hybrid coronary revascularization is associated with lower morbidity and similar in-hospital and 1-year major adverse cerebrovascular or cardiac events rates, but greater requirement for repeat revascularization compared with CABG. Further exploration of this strategy with adequately powered randomized trials is warranted.