Hybrid coronary revascularization versus coronary artery bypass grafting for multivessel coronary artery disease: systematic review and meta-analysis.
BACKGROUND
The concept of hybrid coronary revascularization (HCR) combines the left internal mammary artery (LIMA)-left anterior descending (LAD) graft and percutaneous coronary intervention (PCI) to non-LAD vessels. Multiple comparative studies have evaluated the safety and feasibility of HCR and coronary artery bypass grafting (CABG) for multivessel coronary artery disease (MCAD). However, the sample size of each study was small, and evidences based on single-institutional experience. The purpose of this meta-analysis was to compare the short-term outcomes of HCR with those of CABG for MCAD.


METHODS
PubMed, EMBASE and Cochrane Library databases, as well as conference proceedings, were searched for eligible studies published up to March 2014. We calculated summary odds ratios (OR) for primary endpoints (death, stroke; myocardial infarction (MI); target vessel revascularization (TVR); major adverse cardiac or cerebrovascular events (MACCEs)) and secondary endpoints (atrial fibrillation (AF); renal failure; length of stay in the intensive care unit (LoS in ICU); length of stay in hospital (LoS in hospital); red blood cell (RBC) transfusion). Data from 6176 participants were derived from ten cohort studies.


RESULTS
HCR was non-inferior to CABG in terms of MACCEs during hospitalization (odds ratio (OR), 0.68, 95% confidence interval (CI), 0.34-1.33)and at one-year follow-up(0.32, 0.05-1.89) , and no significant difference was found between HCR and CABG groups in in-hospital and one-year follow-up outcomes of death, MI, stroke, the prevalence of AF and renal failure, whereas HCR was associated with a lower requirement of RBC transfusion and shorter LoS in ICU and LoS in hospital than CABG (weighted mean difference (WMD) -1.25, 95% CI, -1.62 to -0.88; -17.47, -31.01 to -3.93; -1.77, -3.07 to -0.46; respectively).


CONCLUSIONS
Our meta-analysis indicates that HCR is feasible, safe and effective for the treatment of MCAD, with similar in-hospital and one-year follow-up outcome, significantly lower requirement of RBC transfusion, and faster recovery compared with CABG.
Department of Cardiovascular Surgery, Southern Medical University, Guangzhou, People's Republic of China. doctff@gmail.com.|Department of Cardiovascular Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China. doctff@gmail.com.|Department of Cardiovascular Surgery, Xiamen Heart Center, Xiamen, People's Republic of China. doctff@gmail.com.
Peng
P
Zhu
Department of Cardiovascular Surgery, Southern Medical University, Guangzhou, People's Republic of China. alienchoulinger@126.com.|Department of Cardiovascular Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China. alienchoulinger@126.com.
Pengyu
P
Zhou
Department of Cardiovascular Surgery, Southern Medical University, Guangzhou, People's Republic of China. sunyong@126.com.|Department of Cardiovascular Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China. sunyong@126.com.|Department of Cardiovascular Surgery, Xiamen Heart Center, Xiamen, People's Republic of China. sunyong@126.com.
Yong
Y
Sun
Department of Cardiovascular Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China. 847287951@qq.com.
Yilong
Y
Guo
Department of Cardiovascular Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China. 770592050@qq.com.
Mingjie
M
Mai
Department of Cardiovascular Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China. shaoyizheng@yahoo.com.
Shaoyi
S
Zheng
D015331:Cohort Studies; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012086:Reoperation; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome