vs c oronary artery bypass for multivessel disease a metaanalysis Nirav C Patel MD Jonathan M Hemli MD Karthik Seetharam MD Annapoorna Uttara BS Derek R Brinster MD Luigi Pirelli MD Chad ID: 911647
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Slide1
H
ybrid coronary revascularization
vs.
coronary artery bypass for multi-vessel disease: a meta-analysis Nirav C Patel MD, Jonathan M Hemli MD, Karthik Seetharam MD, Annapoorna Uttara BS, Derek R Brinster MD, Luigi Pirelli MD, Chad A Kliger MD, S Jacob Scheinerman MD Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
Results
Background
HCR
and CABG have similar short term
outcomes; HCR is associated with significantly less transfusion.
Methods
Conclusions
Coronary
artery bypass grafting (
CABG) remains the ‘gold standard’ option for many patients with multi-vessel disease disease.1-3The emergence of hybrid coronary revascularization (HCR) has facilitated the advantages of a left internal mammary artery (LIMA) graft to the left anterior descending (LAD), coupled with drug-eluting stents to the other myocardial territories. We sought to conduct a meta-analysis, examining recent studies directly comparing HCR and CABG for patients with multi-vessel disease.
We performed a comprehensive literature search from January 1, 2012 to December 16, 2019 for all eligible studies comparing HCR vs. CABG in PubMed, EMBASE, SCOPUS, and Google Scholar.Clinical outcomes included 30-day mortality, myocardial infarction (MI), stroke, renal failure, perioperative blood transfusion requirements, and new postoperative atrial fibrillation.Nine single-center studies were analyzed, comprising 3032 patients, of whom 1035 had HCR vs. 1997 who underwent traditional CABG.
There was no statistically significant difference between HCR and CABG with respect to 30-day mortality (OR 1.40, p = 0.30), stroke (OR 0.92, p = 0.83), MI (OR 0.56, p = 0.24), new renal failure (OR 0.59, p = 0.13), postoperative atrial fibrillation (OR 0.82, p = 0.28), or requirement for re-intervention (OR 1.05, p = 0.84). HCR was associated with lower blood transfusion requirements than traditional CABG (OR 0.39, p < 0.0001).
Myocardial infarction
Stroke
Renal failure
Transfusion requirements
30-day mortality
Postoperative atrial
f
ibrillation
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Eur J Cardiothorac Surg
2013; 43: 1006-13.
Farkouh ME, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367: 2375-84.