Hybrid coronary revascularization versus percutaneous coronary intervention: A systematic review and meta-analysis. (December 2021)

• Record Type: Journal Article
• Authors: Van den Eynde, Jef; Sá, Michel Pompeu; De Groote, Senne; Amabile, Andrea; Sicouri, Serge; Ramlawi, Basel; Torregrossa, Gianluca; Oosterlinck, Wouter
• Is Part Of: IJC heart & vasculature. Volume 37(2021)
• Publication Date: 2021-12
• Subjects: Hybrid coronary revascularization -- Percutaneous coronary Intervention -- Meta-analysis -- 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; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2021.100916
• Languages: English
• ISSNs: 2352-9067

Abstract

Graphical abstract: Highlights: Hybrid coronary revascularization (HCR) for multivessel disease (MVD) is emerging. This meta-analysis compared HCR to percutaneous coronary intervention (PCI) Both procedures had comparable 30-day outcomes. HCR had less myocardial infarction and target vessel revascularization at follow-up. More randomized controlled trials comparing both approaches are needed. 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.