Nolan Sabrina, Filion Kristian B, Atallah Renee, Moss Emmanuel, Reynier Pauline, Eisenberg Mark J
Professor of Medicine, Jewish General Hospital/McGill University, 3755 Côte Ste-Catherine Road, Suite H-421.1, Montreal, Quebec, Canada H3T 1E2.
J Invasive Cardiol. 2018 Dec;30(12):E131-E149.
Hybrid coronary revascularization (HCR) has emerged as a potential alternative to complete coronary artery bypass graft (CABG) surgery. However, the efficacy and safety of HCR vs CABG remain unclear. We therefore conducted a systematic review and meta-analysis to compare these interventions.
We systematically searched PubMed, MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Library of Clinical Trials, and the Web of Science for studies comparing HCR to CABG in patients with multivessel coronary artery disease. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE) and its components (myocardial infarction, stroke, mortality, and target-vessel revascularization [TVR]) at ≥1 year. Secondary outcomes included MACCE at ≤30 days, its components, and postoperative safety outcomes (renal failure, blood transfusion, new-onset atrial fibrillation, and infection).
One randomized controlled trial and 9 cohort studies were included in our systematic review. Pooled results indicate that HCR is associated with a lower risk for postoperative blood transfusion (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68) and infection (OR, 0.19; 95% CI, 0.04-0.98), and a shorter hospital stay (6.0 days for HCR vs 7.8 days for CABG) and intensive care unit (ICU) stay (25.4 hours for HCR vs 45.7 hours for CABG). Long-term outcome data showed an association between HCR and long-term TVR (OR, 3.10; 95% CI, 1.39-6.90).
Our results suggest that compared to CABG, HCR is associated with a lower risk of postoperative blood transfusion and infection, as well as a shorter ICU stay and hospital stay. HCR was also associated with a higher risk of long-term TVR.
杂交冠状动脉血运重建术（HCR）已成为完全冠状动脉旁路移植术（CABG）的一种潜在替代方案。然而，HCR与CABG相比的疗效和安全性仍不明确。因此，我们进行了一项系统评价和荟萃分析以比较这些干预措施。
我们系统检索了PubMed、MEDLINE（通过Ovid）、EMBASE（通过Ovid）、Cochrane临床试验图书馆和科学网，以查找比较多支冠状动脉疾病患者中HCR与CABG的研究。主要结局是≥1年时的主要不良心血管和脑血管事件（MACCE）及其组成部分（心肌梗死、中风、死亡率和靶血管血运重建[TVR]）。次要结局包括≤30天时的MACCE、其组成部分以及术后安全性结局（肾衰竭、输血、新发房颤和感染）。
我们的系统评价纳入了1项随机对照试验和9项队列研究。汇总结果表明，HCR与术后输血风险较低（比值比[OR]，0.43；95%置信区间[CI]，0.27 - 0.68）和感染风险较低（OR，0.19；95%CI，0.04 - 0.98）相关，并且住院时间较短（HCR为6.0天，CABG为7.8天）以及重症监护病房（ICU）住院时间较短（HCR为25.4小时，CABG为45.7小时）。长期结局数据显示HCR与长期TVR之间存在关联（OR，3.10；95%CI，1.39 - 6.90）。
我们的结果表明，与CABG相比，HCR与术后输血和感染风险较低以及ICU住院时间和住院时间较短相关。HCR还与长期TVR风险较高相关。
