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Published on: March 27, 2018
Long-Term Outcomes After Hybrid Coronary Revascularization Versus Coronary Artery Bypass Grafting: Meta-Analysis of
Junichi Shimamura1, Yoshihisa Miyamoto2, Makoto Hibino3
1Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York.
Insights
Hybrid coronary revascularization (HCR) shows similar long-term survival to coronary artery bypass grafting (CABG) despite higher rates of major adverse cardiac and cerebrovascular events (MACCEs) and repeat revascularization. Further research is needed to clarify HCR
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Outcomes Research
Background:
- Long-term outcomes comparing Hybrid Coronary Revascularization (HCR) and Conventional Coronary Artery Bypass Grafting (CABG) for multivessel coronary artery disease are not well-defined.
- Assessing the comparative efficacy and safety of HCR versus CABG is crucial for clinical decision-making in complex coronary artery disease management.
Approach:
- A meta-analysis was conducted using studies from PubMed and EMBASE (inception to March 2023) that reported Kaplan-Meier curves with at least one-year follow-up.
- Included studies focused on patients with multivessel coronary artery disease, comparing HCR and CABG outcomes.
- Primary outcome was all-cause mortality; secondary outcomes included Major Adverse Cardiac and Cerebrovascular Events (MACCEs) and repeat revascularization.
Key Points:
- HCR demonstrated similar overall long-term mortality compared to CABG (HR 1.09, 95% CI 0.87-1.36).
- HCR was associated with a significantly higher incidence of MACCEs (HR 1.49, 95% CI 1.07-2.06) and repeat revascularization (HR 2.01, 95% CI 1.53-2.64) versus CABG.
- MACCEs were higher in HCR mid-term but similar long-term; repeat revascularization was consistently higher with HCR.
Conclusions:
- Despite increased MACCEs and repeat revascularization, HCR provides comparable long-term survival to CABG in multivessel coronary artery disease.
- Longer-term follow-up and large-scale randomized controlled trials are necessary to fully elucidate the role of HCR in treating multivessel coronary artery disease.
Abstract:
Hybrid coronary revascularization (HCR) is an alternative option to conventional coronary artery bypass grafting (CABG), but the long-term outcomes of HCR versus CABG remain unclear. We aimed to analyze the long-term outcomes after HCR and CABG for patients with multivessel coronary artery disease using meta-analysis. A systemic literature search of PubMed and EMBASE was performed from inception to March 2023. Studies reporting Kaplan-Meier curves with follow-up ≥1 year were included. The primary outcome was all-cause mortality, and the secondary outcomes were major adverse cardiac and cerebrovascular events (MACCEs) and repeat revascularization. In total, 13 studies (1 randomized controlled trial and 12 propensity-score matched observational studies) were analyzed. The mean follow-up period was 5.1 ± 3.1 years. HCR was associated with similar overall mortality (hazard ratio [HR] 1.09, 95% confidence interval [CI] 0.87 to 1.36), significantly higher incidence of MACCEs (HR 1.49, 95% CI 1.07 to 2.06), and repeat revascularization (HR 2.01, 95% CI 1.53 to 2.64) compared with CABG. In phase-specific analysis, the mortality rate was similar, and the incidence of repeat revascularization was higher in HCR regardless of phases. The incidence of MACCEs was higher in HCR during the mid-term phase (1 to 5 years), but it was similar during the long-term phase (long-term: ≥5 years). In conclusion, despite the higher incidence of MACCEs and repeat revascularization compared with CABG, HCR offered a similar long-term survival. Even longer-term follow-up and randomized controlled trials with a large population are warranted to investigate the role of HCR for multivessel coronary artery disease.
