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

Abstract

Graphical abstract

Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta‐analysis of 14 studies comprising 4226 patients

“…In this meta‐analysis, HCR and CABG had comparable rates of mortality and MACCE on both short‐ and long‐term follow up, findings that are in line with the results of previous meta‐analyses such as those by Hinojosa‐Gonzalez et al, Sardar et al, Zhu et al, and Reynolds et al 22,42–44 However, the durability of HCR was challenged with a significantly higher odds of repeat revascularization compared to CABG on long‐term follow‐up. This finding contrasts with a previous meta‐analysis by Sardar et al, 22 that reported similar rates of repeat revascularization between HCR and CABG groups and Van den Eynde et al 45 who reported a significantly lower rate of repeat revascularization in the HCR group compared to the CABG group. This difference could be explained by the relatively small sample size of the meta‐analysis by Sardar et al 22 and the fact that a fixed‐effect model meta‐analysis was conducted in both 45 .…”

“…This finding contrasts with a previous meta-analysis by Sardar et al, 22 that reported similar rates of repeat revascularization between HCR and CABG groups and Van den Eynde et al 45 who reported a significantly lower rate of repeat revascularization in the HCR group compared to the CABG group. This difference could be explained by the relatively small sample size of the metaanalysis by Sardar et al 22 and the fact that a fixed-effect model meta-analysis was conducted in both.…”

“…In respect to postoperative MI, it is important to note that subgroup analysis consisting of RCTs found a higher risk of postoperative MI with HCR, although not significant. In contrast, Van den Eynde et al 45,59 in two separate meta-analyses of both observational studies and RCTs found HCR to be associated with a significantly lower risk of MI both postoperatively 45 and on long-term followup. 59 Despite a relatively large study population, the authors did not conduct sensitivity analysis with only randomized trials, which typically have a more rigorous methodology compared to observational studies, and could have revealed a reliable and more accurate estimate of the risk of MI between HCR and CABG groups.…”

“…This difference could be explained by the relatively small sample size of the metaanalysis by Sardar et al 22 and the fact that a fixed-effect model meta-analysis was conducted in both. 45 It is important to note that outcomes of HCR, particularly in-stent restenosis (ISR) leading to repeat revascularization, can vary significantly depending on the type of stent used in non-LAD territories (i.e., baremetal stents vs. drug eluting stents), type of DES (first vs. second-generation), and technique of implantation (e.g., stent sizing, post dilatation, and use of intravascular imaging). 21,[46][47][48][49][50] For patients undergoing PCI with DES, freedom from 10-year target lesion revascularization rates conventionally range 70%−85%.…”

Robotic‐assisted versus conventional off‐pump coronary surgery in women: A propensity‐matched study

“…Furthermore, contrarily to the widespread belief, hybrid procedures with stents did not yield worse results over time in comparison with the nonhybrid group (likely owing to the evolution of drug‐eluting stents). We demonstrated in previous studies that patients treated surgically for coronary disease can be equally treated with LIMA to LAD plus saphenous vein grafts or stents for non‐LAD vessels with similar long‐term outcomes, 27–29 suggesting that contemporary stents can be as effective as other grafts to treat non‐LAD lesions. There is an interesting aspect in our study which we should highlight.…”