Hybrid coronary revascularization vs percutaneous coronary intervention for
Hybrid coronary revascularization vs. percutaneous coronary intervention for multi-vessel disease: a meta-analysis Nirav C Patel MD, Jonathan M Hemli MD, Karthik Seetharam MD, Annapoorna Uttara BS, Joel Johnson MD, Iam Claire Sarmiento BSN, Derek R Brinster MD, Luigi Pirelli MD, Chad A Kliger MD, Efstathia A Mihelis MBA, S Jacob Scheinerman MD Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA Background Results v Although percutaneous coronary intervention (PCI) is a well-established approach for multi-vessel coronary disease, a potentially greater incidence of repeat revascularization remains a concern. 1 v In the short term, there was no statistically significant difference between HCR and PCI with respect to 30 day mortality (OR 0. 22, p = 0. 32), myocardial infarction (MI) (OR 0. 42, p = 0. 45), or stroke (OR 0. 53, p = 0. 70). v Hybrid coronary revascularization (HCR) facilitates the advantages of a left internal mammary artery (LIMA) graft to the left anterior descending (LAD), coupled with PCI to the other myocardial territories. v There was also no difference between HCR and PCI for later mortality (OR 0. 28, p = 0. 12) or stroke (OR = 0. 58, p = 0. 36). v We conducted a meta-analysis of those studies directly comparing HCR and PCI for patients with multi-vessel disease. Perioperative myocardial infarction Late mortality v HCR was associated with a significantly lower incidence of late MI vs. PCI (OR 0. 13, p = 0. 008). 30 -day mortality Late stroke Methods v We performed a comprehensive literature search from January 1, 2012 to December 16, 2019 for all eligible studies comparing HCR vs. PCI in Pub. Med, EMBASE, SCOPUS, and Google Scholar. v Clinical outcomes included 30 -day mortality, myocardial infarction (MI), and stroke, as well as similar end-points assessed in the mid to longer-term. Perioperative stroke Late myocardial infarction v Four single-center studies were analyzed, comprising 751 patients, of whom 355 had HCR vs. 396 who underwent multi-vessel PCI utilizing drug-eluting stents. Conclusions 1. Parasca CA, et al. Incidence, characteristics, predictors, and outcomes of repeat revascularization after percutaneous coronary intervention and coronary artery bypass grafting: the SYNTAX trial at 5 years. J Am Coll Cardiol Intv 2016; 9: 2493 -507. v HCR and PCI have similar short-term outcomes; HCR is associated with a lower incidence of late MI.
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