多支血管冠状动脉疾病（MVCAD）中的杂交冠状动脉血运重建（HCR）与冠状动脉旁路移植术（CABG）的比较：包含 4226 例患者的 14 项研究的荟萃分析。

Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta-analysis of 14 studies comprising 4226 patients.

机构信息

Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, New York, USA.

University of Cincinnati Medical Center, Cincinnati, Ohio, USA.

出版信息

Catheter Cardiovasc Interv. 2022 Dec;100(7):1182-1194. doi: 10.1002/ccd.30446. Epub 2022 Nov 6.

DOI:10.1002/ccd.30446

PMID:36335643

Abstract

OBJECTIVES

To compare the outcomes of hybrid coronary revascularization (HCR) with traditional coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD).

BACKGROUND

HCR has emerged as an alternative to CABG in patients with MVCAD. Through minimally invasive surgical techniques, HCR carries the potential for faster recovery postoperatively, fewer complications, and lower utilization of resources.

METHODS

Systematic search of electronic databases was conducted up to December 2021 and studies comparing HCR with CABG in the treatment of MVCAD were included in this meta-analysis. Primary outcomes of interest were incidence of 5-year mortality and major adverse cardiac and cerebral event (MACCE).

RESULTS

Fourteen studies (12 observational studies and 2 randomized controlled trials) comprising 4226 patients were included. The rates of 5-year mortality (odds ratios [OR]: 1.55; 95% confidence interval [CI]: 0.92-2.62; I = 83.0%) and long-term MACCE (OR: 0.97; 95% CI: 0.47-2.01; I = 74.7%) were comparable between HCR and CABG groups. HCR was associated with a significantly lower likelihood of perioperative blood transfusion (OR: 0.36; 95% CI: 0.25-0.51; I = 55.9%), shorter mean hospital stay (weighted mean difference: -2.04; 95% CI: -2.60 to -1.47; I = 54%), and risk of postoperative acute kidney injury (OR: 0.45; 95% CI: 0.23-0.88; p = 0.02). CABG demonstrated a lower likelihood of requiring long-term repeat revascularization (OR: 1.51; 95% CI: 1.03-2.20; I = 18%) over a follow-up duration of 29.14 ± 21.75 months.

CONCLUSION

This meta-analysis suggests that HCR is feasible and safe for the treatment of MVCAD. However, benefits of HCR should be carefully weighed against the increased long-term risk of repeat-revascularization when selecting patients, and further studies evaluating differences in long-term mortality between HCR and CABG are required.

摘要

目的

比较杂交冠状动脉血运重建术（HCR）与传统冠状动脉旁路移植术（CABG）治疗多支冠状动脉疾病（MVCAD）的效果。

背景

HCR 已成为 MVCAD 患者 CABG 的替代方法。通过微创外科技术，HCR 具有术后恢复更快、并发症更少、资源利用更低的潜力。

方法

系统检索电子数据库，截至 2021 年 12 月，纳入比较 HCR 与 CABG 治疗 MVCAD 的荟萃分析。主要观察终点为 5 年死亡率和主要心脏和脑血管不良事件（MACCE）发生率。

结果

纳入 14 项研究（12 项观察性研究和 2 项随机对照试验），共 4226 例患者。HCR 组与 CABG 组的 5 年死亡率（比值比 [OR]：1.55；95%置信区间 [CI]：0.92-2.62；I²=83.0%）和长期 MACCE（OR：0.97；95%CI：0.47-2.01；I²=74.7%）发生率相当。HCR 组与 CABG 组相比，围手术期输血的可能性显著降低（OR：0.36；95%CI：0.25-0.51；I²=55.9%），平均住院时间缩短（加权均数差：-2.04；95%CI：-2.60 至-1.47；I²=54.9%），术后急性肾损伤风险降低（OR：0.45；95%CI：0.23-0.88；p=0.02）。在 29.14±21.75 个月的随访中，CABG 组需要长期再次血运重建的可能性较低（OR：1.51；95%CI：1.03-2.20；I²=18%）。