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Hybrid coronary revascularization reduced morbidity vs. CABG
Hybrid coronary revascularization was associated with lower morbidity compared with CABG and similar rates of death and MI in a recent review analysis.
An international group of researchers described hybrid coronary revascularization (HCR) as a minimally invasive strategy. The method involves the combination of PCI with the durability of an internal mammary artery to left anterior descending artery graft. The intervention can be used to treat remaining lesions, according to the researchers.
The current systematic review and meta-analysis compared clinical outcomes of the hybrid approach with CABG in a cohort of 1,190 patients culled from six observational studies. The EMBASE and PUBMED search included one case-control study and five propensity adjusted studies. In-hospital and 1-year mortality served as the primary outcome measure, along with MI, stroke and repeat revascularization.
HCR was performed in 30.8% of the cohort. Of these 366 procedures, 185 were staged and 181 were concurrent. The CABG rate was 69.2%, with 786 off-pump and 38 on-pump procedures included.
In the HCR cohort, 89.6% received DES.
Lower in-hospital need for blood transfusions occurred in the hybrid coronary revascularization cohort. This intervention was also associated with a shorter length of hospital stay and a faster return to work.
The composite of death, MI, stroke or repeat revascularization did not significantly differ for HCR vs. CABG (OR=0.63; 95% CI, 0.25-1.58; P=.33) during hospitalization, nor did it at 1-year follow-up (OR=0.49; 95% CI 0.20-1.24; P=.13). There were also no significant differences reported with regard to all-cause death, MI or stroke in individual comparisons of the outcome measures. However, patients in the HCR cohort experienced higher rates of repeat revascularization.
“These findings seem to be similar irrespective of whether a one- or two-staged approach is used,” the researchers wrote. “Our findings may be used as reference for future clinical trials comparing HCR with CABG.”
Disclosure: The researchers report financial disclosures with Aastrom Biosciences, Abbott Laboratories, Abiomed, Acorn Cardiovascular, Bristol-Myers Squibb, CLS Behring, Cordis Corporation, Daiichi Sankyo/Eli Lilly, Genzyme Corporation, Ikaria, Johnson & Johnson, Maquet Cardiovascular, Moerae Matrix, Regado Biosciences, Sanofi-Aventis, Somahlution, Terumo Medical, The Medicines Company and Zoll.