Clinical InvestigationInterventional CardiologyClinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery: a meta-analysis of 1,190 patients
Section snippets
Data source and exclusion criteria
A comprehensive literature search was performed from electronic databases including Cochrane Library, EMBASE, and MEDLINE updated to June 26, 2013. The terms “hybrid coronary revascularization,” “hybrid myocardial revascularization,” “integrated myocardial revascularization,” and “coronary artery disease” and their variations were used as keywords in a PubMed search. The search was limited to records in humans. Both English and non-English language articles were included (n = 247). Two
Studies selection
The study selection process is illustrated in Figure 1. The search strategy identified 247 studies. After screening of titles and abstracts, we excluded nonoriginal studies, case reports, or small case series (<10) and unrelated studies on noncoronary hybrid surgical or imaging procedures. This resulted in 37 unique studies that were comprehensively reviewed. After critical appraisal, we excluded 27 studies because of the lack of a comparative study arm, clinical outcome was not provided, or
Discussion
In this meta-analysis of more than 1,100 patients from 6 observational cohort studies, we observed the following: (1) patients undergoing HCR with IMA-to-LAD grafting and PCI of non-LAD lesions have a similar risk of the composite of death, MI, stroke, and repeat revascularization than those treated with CABG during hospitalization and during follow-up; (2) although death, MI, and stroke rates were numerically but not statistically lower with HCR, the need for repeat revascularization occurred
Conclusion
In this contemporary meta-analysis of patients with multivessel CAD undergoing coronary revascularization, HCR was associated with similar rates of death, MI, stroke, and repeat revascularization during hospitalization and at follow-up, but with higher rates of repeat revascularization compared with conventional CABG. These findings seem to be similar irrespective of whether a 1-staged or 2-staged approach is used. Our findings may be used as reference for future clinical trials comparing HCR
Disclosures
Drs Harskamp, Bagai, Bachinsky, and de Winter do not report any relevant disclosures. Dr Rao receives research grants from Cordis Corportation, Ikaria, and Sanofi-Aventis and received consulting fees for Zoll, the Medicines Company, Terumo Medical, and Daiichi Sankyo Lilly. Dr Patel receives research funding from MAQUET Cardiovascular, Johnson & Johnson, The National Heart, Lung, and Blood Institute, and Agency for Healthcare Research and Quality's and consulting fees from Genzyme corporation.
References (19)
- et al.
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J Am Coll Cardiol
(2012) - et al.
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions
J Am Coll Cardiol
(2011) - et al.
Combination of minimally invasive coronary bypass and percutaneous transluminal coronary angioplasty in the treatment of double-vessel coronary disease: two-year follow-up of a new hybrid procedure compared with “on-pump” double bypass grafting
Am Heart J
(2001) - et al.
Hybrid revascularization, comprising coronary artery bypass graft with exclusive arterial conduits followed by early drug-eluting stent implantation, in multivessel coronary artery disease
Arch Cardiovasc Dis
(2010) - et al.
Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass
J Thorac Cardiovasc Surg
(2008) - et al.
One-stop hybrid coronary revascularization versus coronary artery bypass graft and percutaneous coronary intervention for the treatment of multivessel coronary artery disease: three-year follow-up results from a single institution
J Am Coll Cardiol
(2013) - et al.
Minimally invasive direct coronary artery bypass (MIDCAB) versus coronary artery stenting for elective revascularization of the left anterior descending artery
Am J Cardiol
(2002) - et al.
Clinical and angiographic correlates of short- and long-term mortality in patients undergoing coronary artery bypass grafting
Am J Cardiol
(2007) - et al.
Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room
J Am Coll Cardiol
(2009)
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2021, Annals of Thoracic SurgeryCitation Excerpt :Studies that compared hybrid coronary revascularization (HCR) in 2 or more diseased vessels (minimally invasive CABG plus PCI) arrived at similar conclusions. Harskamp and colleagues22 conducted a meta-analysis of 6 studies with a total of 366 HCR patients and 824 CABG patients. The authors found no differences in the composite of death, MI, stroke, or repeat revascularization during hospitalization.
Marc Cohen, MD, served as guest editor for this article.