Hybrid coronary revascularization versus percutaneous coronary intervention: A systematic review and meta-analysis

Jef Van den Eynde; Michel Pompeu Sá; Senne De Groote; Andrea Amabile; Serge Sicouri; Basel Ramlawi; Gianluca Torregrossa; Wouter Oosterlinck

doi:10.1016/j.ijcha.2021.100916

Hybrid coronary revascularization versus percutaneous coronary intervention: A systematic review and meta-analysis

Int J Cardiol Heart Vasc. 2021 Dec 1:37:100916. doi: 10.1016/j.ijcha.2021.100916. eCollection 2021 Dec.

Authors

Jef Van den Eynde^{1

2}, Michel Pompeu Sá^{3

4}, Senne De Groote¹, Andrea Amabile⁵, Serge Sicouri⁴, Basel Ramlawi^{3

4}, Gianluca Torregrossa³, Wouter Oosterlinck¹

Affiliations

¹ Department of Cardiovascular Diseases, University Hospitals Leuven & Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
² Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, USA.
³ Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health Wynnewood, PA, USA.
⁴ Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA.
⁵ Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.

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.

Keywords: CABG, coronary artery bypass grafting; CI, confidence interval; Clinical outcomes; HCR, hybrid coronary revascularization; 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; Meta-analysis; OR, odds ratio; PCI, percutaneous coronary intervention; PRISMA, Preferred Reporting Items for Systematic reviews Meta-Analyses; Percutaneous coronary Intervention; TVR, target vessel revascularization.

Publication types

Review