Duke Clinical Research Institute and Duke University Medical Center, Durham, NC; Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Am Heart J. 2014 Apr;167(4):585-92. doi: 10.1016/j.ahj.2014.01.006. Epub 2014 Jan 29.
Hybrid coronary revascularization (HCR) represents a minimally invasive revascularization strategy in which the durability of the internal mammary artery to left anterior descending artery graft is combined with percutaneous coronary intervention to treat remaining lesions. We performed a systematic review and meta-analysis to compare clinical outcomes after HCR with conventional coronary artery bypass graft (CABG) surgery.
A comprehensive EMBASE and PUBMED search was performed for comparative studies evaluating in-hospital and 1-year death, myocardial infarction (MI), stroke, and repeat revascularization.
Six observational studies (1 case control, 5 propensity adjusted) comprising 1,190 patients were included; 366 (30.8%) patients underwent HCR (185 staged and 181 concurrent), and 824 (69.2%) were treated with CABG (786 off-pump, 38 on-pump). Drug-eluting stents were used in 328 (89.6%) patients undergoing HCR. Hybrid coronary revascularization was associated with lower in-hospital need for blood transfusions, shorter length of stay, and faster return to work. No significant differences were found for the composite of death, MI, stroke, or repeat revascularization during hospitalization (odds ratio 0.63, 95% CI 0.25-1.58, P = .33) and at 1-year follow-up (odds ratio 0.49, 95% CI 0.20-1.24, P = .13). Comparisons of individual components showed no difference in all-cause mortality, MI, or stroke, but higher repeat revascularization among patients treated with HCR.
Hybrid coronary revascularization is associated with lower morbidity and similar in-hospital and 1-year major adverse cerebrovascular or cardiac events rates, but greater requirement for repeat revascularization compared with CABG. Further exploration of this strategy with adequately powered randomized trials is warranted.
杂交冠状动脉血运重建（HCR）代表了一种微创血运重建策略，它结合了内乳动脉到前降支的持久通畅性和经皮冠状动脉介入治疗来处理剩余病变。我们进行了一项系统评价和荟萃分析，以比较 HCR 与常规冠状动脉旁路移植术（CABG）的临床结局。
对比较研究进行了全面的 EMBASE 和 PUBMED 检索，评估了住院期间和 1 年的死亡、心肌梗死（MI）、卒中和再次血运重建的情况。
纳入了 6 项观察性研究（1 项病例对照，5 项倾向评分调整），共 1190 例患者；366 例（30.8%）患者接受了 HCR（185 例分期，181 例同期），824 例（69.2%）接受了 CABG（786 例非体外循环，38 例体外循环）。328 例（89.6%）接受 HCR 的患者使用了药物洗脱支架。与 CABG 相比，HCR 术中需要输血的比例较低，住院时间较短，术后恢复工作的速度较快。在住院期间（比值比 0.63，95%可信区间 0.25-1.58，P =.33）和 1 年随访时（比值比 0.49，95%可信区间 0.20-1.24，P =.13），死亡、MI、卒中和再次血运重建的复合终点无显著差异。比较单个组成部分，发现全因死亡率、MI 或卒中等方面无差异，但 HCR 治疗的患者再次血运重建的比例较高。
与 CABG 相比，HCR 与较低的发病率相关，且住院期间和 1 年主要不良心脑血管事件发生率相似，但需要再次血运重建的比例较高。需要进一步进行具有足够效力的随机试验来探索这种策略。
