Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, Hybrid coronary revascularization, Percutaneous coronary Intervention, Meta-analysis, Clinical outcomes, ARTERY-DISEASE, CLINICAL-OUTCOMES, CABG, coronary artery bypass grafting, CI, confidence interval, HCR, hybrid coronary revascularization, LAD, left anterior descending coronary artery, LITA, left internal thoracic artery, MACCE, major adverse cardiac and cerebrovascular events, MD, mean difference, MI, myocardial infarction, MVD, multivessel coronary artery disease, OR, odds ratio, PCI, percutaneous coronary intervention, PRISMA, Preferred Reporting Items for Systematic reviews Meta-Analyses, TVR, target vessel revascularization, PROCEDURAL MYOCARDIAL-INFARCTION, DEFINITIONS, 3201 Cardiovascular medicine and haematology

Abstract:

BACKGROUND: Hybrid coronary revascularization (HCR) is an emerging approach for multivessel coronary artery disease (MVD) which combines the excellent long-term outcomes of surgery with the early recovery and reduced short-term complications of percutaneous coronary intervention (PCI). Here, we evaluated the effectiveness of HCR compared to PCI in patients with MVD. METHODS: A systematic database search in PubMed/MEDLINE, Embase, Scopus, and CENTRAL/CCTR was conducted by June 2021. Random-effects meta-analysis was performed, comparing major adverse cardiac and cerebrovascular events (MACCE) at 30 days and at latest follow-up between patients undergoing HCR versus PCI. RESULTS: A total of 27,041 patients (HCR: 939 patients, PCI: 26,102 patients) were included from seven studies published between 2013 and 2021. At latest follow-up, HCR was associated with lower rates of myocardial infarction (OR 0.40, 95% CI 0.20-0.80, p = 0.010) and target vessel revascularization (OR 0.49, 95% CI 0.37-0.64, p < 0.001), while the difference for MACCE did not reach statistical significance (OR 0.46, 95% CI 0.20-1.05, p = 0.061). No differences were observed in terms of 30-day outcomes, nor rates of mortality or stroke at latest follow-up. CONCLUSIONS: HCR might be a valid alternative to multivessel PCI, demonstrating a lower incidence of MI and TVR. Center experience, well-coordinated heart team discussions, and good patient selection likely remain essential to ensure optimal outcomes. Future comparative studies are required to define the optimal target population.