Hybrid coronary revascularization versus coronary artery bypass grafting in patients with multivessel coronary artery disease: A meta-analysis

Objectives: This meta-analysis evaluated the effectiveness of hybrid coronary revascularization (HCR) compared to coronary artery bypass grafting (CABG) for the treatment of multivessel coronary artery disease (MVCAD). Background: HCR involves a combination of surgical and percutaneous techniques, which in selected patients may present an alternative to conventional CABG. Methods: Databases were searched through June 30, 2016, and studies comparing HCR with CABG for treatment of MVCAD were selected. We calculated summary odds ratios (ORs) and 95% CIs with the random-effects model. The primary outcome of interest was the occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of all cause mortality, myocardial infarction, and stroke. Results: The analysis included 2,245 patients from 8 studies (1 randomized controlled trial and 7 observational studies). The risk of MACCE with HCR and CABG were 3.6% and 5.4%, respectively (OR, 0.53; 95% CI, 0.24–1.16). Compared to CABG group, patients in HCR group had similar risk of all cause mortality (OR, 0.85; 95% CI, 0.38–1.88), myocardial infarction (OR, 0.72; 95% CI, 0.31–1.64), stroke (OR, 0.53; 95% CI, 0.23–1.20), and repeat revascularization (OR, 1.28; 95% CI, 0.58–2.83). The need for postoperative blood transfusions (OR, 0.29; 95% CI, 0.14–0.59) and hospital stay (weighted mean difference −1.20 days; 95% CI −1.52 to −0.88 days) was significantly lower in the HCR group. Conclusion: HCR appears to be safe, and has similar outcomes when compared with conventional CABG. HCR can be a suitable alternative to conventional CABG in select patients with MVCAD.