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Is hybrid coronary revascularization really beneficial in the long term?

Chuan Wang1, Ping Li1, Fan Zhang1

  • 1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|June 21, 2021
PubMed

Insights

Hybrid coronary revascularization (HCR) offers lower short-term risks than coronary artery bypass grafting (CABG). Long-term outcomes for HCR and CABG are similar, making HCR a feasible option for multivessel coronary artery disease.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Technology

Background:

  • Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
  • Traditional coronary artery bypass grafting (CABG) is a standard treatment for severe CAD.
  • Hybrid coronary revascularization (HCR) combines surgical and percutaneous interventions for revascularization.

Purpose of the Study:

  • To compare short- and long-term outcomes of hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG).
  • To evaluate different HCR techniques (simultaneous vs. staged) in comparison to CABG.
  • To assess the efficacy and safety of HCR in patients with multivessel coronary artery disease.

Main Methods:

  • A systematic review and network meta-analysis of 23 studies.
  • Inclusion of 10,468 patients: 2403 undergoing HCR and 8065 undergoing CABG.
  • Comparison of outcomes including mortality, stroke, myocardial infarction, major adverse cardiac and cerebrovascular events (MACCE), and blood transfusion (BT).

Main Results:

  • HCR demonstrated significantly lower risks of stroke, MACCE, and blood transfusion compared to CABG in the short term.
  • Simultaneous HCR showed better outcomes for stroke and MACCE, while staged HCR was superior for BT.
  • No significant long-term differences in survival or MACCE rates were observed between HCR and CABG.

Conclusions:

  • Hybrid coronary revascularization (HCR) is a feasible and effective treatment option for multivessel coronary artery disease.
  • Short-term results favor HCR due to reduced adverse events, particularly stroke and MACCE.
  • Long-term efficacy, including survival and freedom from MACCE, is comparable between HCR and traditional CABG.
Abstract

Keywords:
Coronary artery bypass graftingHybrid coronary revascularizationMajor adverse cardiac and cerebrovascular eventsNetwork meta-analysisSurvival

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