A Meta-analysis Of Hybrid Coronary Revascularization Versus Percutaneous Coronary Intervention For Multi- Vessel Coronary Artery Disease
Nirav Patel, Jonathan Hemli, Karthik Seetharam, Ananmay Uttara, Joel Johnson, Iam Claire Sarmiento, Derek Brinster, Luigi Pirelli, Chad Kliger, Efstathia Mihelis, Samuel Scheinerman.
Lenox Hill Hospital, New York, NY, USA.
Background: Although percutaneous coronary intervention (PCI) is a clearly established approach for coronary artery disease (CAD) but repeat revascularization is a frequent complication. Newer alternative modalities such as hybrid coronary revascularization (HCR) are gaining prominence, this approach utilizes left internal mammary artery (LIMA) to the left anterior descending artery (LAD) and drug eluting stents for non-LAD lesions. We sought to conduct a meta-analysis analyzing recent studies comparing complications between HCR and PCI. Methods: We performed a comprehensive literature search for all eligible studies comparing HCR and CABG in PubMed, EMBASE, SCOPUS, and Google Scholar. Clinical outcomes comprised of short term and long term outcomes. Results: Four single center studies were deemed eligible which consisted of 751 patients which consisted of 355 HCR and 396 PCI patients. In short term, there was no statistical difference between HCR and PCI for mortality (OR= .22, 95% CI (.01- 4.39), p= .32), myocardial infarction (OR= 0.42, 95% CI (0.04- 4.05), p= 0.45), and stroke (OR= 0.53, 95% CI (0.02- 13.22), p= 0.70). In Long term, HCR had a statistically lower MI (OR= .13, 95% CI (.03- .59, p= 0.008), close to significant lower mortality (OR= .28, 95% Cl (.06- 1.37, p= 0.12), and no differences in stroke (OR= 0.58, 95% Cl 0.18- 1.87, p= 0.36). Conclusion: For long term outcomes, HCR has lower MI and close to significant lower mortality. Further studies are required.
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