A Meta-analysis Of Hybrid Coronary Revascularization Versus Coronary Artery Bypass Grafting For Multi- Vessel Coronary Artery Disease
Nirav Patel, Jonathan Hemli, Karthik Seetharam, Ananmay Uttara, Derek Brinster, Luigi Pirelli, Chad Kliger, Samuel Scheinerman.
Lenox Hill Hospital, New York, NY, USA.
Background: Coronary Bypass Grafting Surgery (CABG) is heralded as the gold standard option for multi-vessel disease coronary artery disease (CAD). The emergence of hybrid coronary revascularization (HCR) has enabled alternative options in CAD intervention by combining left internal mammary artery utilization and drug- eluting stent implantation. We sought to conduct a meta-analysis analyzing recent studies comparing complications between HCR and CABG. Methods: We performed a comprehensive literature search from January 1st, 2012 to December 16th, 2019 for all eligible studies comparing HCR and CABG in PubMed, EMBASE, SCOPUS, and Google Scholar. Clinical outcomes comprised of 30 day- mortality, myocardial infarction (MI), stroke, renal failure, re-intervention, blood transfusion units, post-operative atrial fibrillation. Results: Nine single center studies were deemed eligible which consisted of 3032 patients which consisted of 1035 HCR and 1997 CABG patients. There was no statistical difference between HCR and CABG for stroke (OR 0.92, 95% CI 0.41- 2.04, P= 0.83), 30 day mortality (OR 1.40, 95% Cl 0.74- 2.64, P= 0.30), MI (OR 0.56, 95% Cl 0.22- 1.47, P= 0.24), renal failure (OR 0.59, 95% Cl 0.29- 1.18, P= 0.13), post- operative atrial fibrillation (OR 0.82, 95% Cl 0.58- 1.17, P= 0.28), and re-intervention (OR 1.05, 95% Cl 0.63- 1.75, P= 0.84). HCR was associated with lower blood transfusion (OR 0.39 95%, Cl 0.26- 0.57, P= <.000001) Conclusion: HCR and CABG have similar short term outcomes but HCR had significantly lower blood transfusion utilization.
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