One-stop Composite Coronary Revascularization Surgery And Coronary Artery Bypass Graft Surgery And Percutaneous Coronary Intervention In The Treatment Of Coronary Artery Multivessel Disease, The Interim Efficacy Of The Comparative Study

Background:One stop hybrid coronary revascularization (HCR) combines the best of minimal invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI) for the treatment of coronary artery multivessel disease, in order to achieve the minimally invasive and completely revascularization treatment.Objective:We retrospectively analysis the midterm outcomes of one-stop hybrid coronary revascularization compared with coronary artery bypass grafting (CABG) and PCI, and compared the cost-effectiveness between the three groups.Methods:141patients with multivessel disease underwent one-stop hybrid coronary revascularization at our institution between June2007and December2010. And we identified patients who had undergone CABG (n=141) and PCI (n=141) by propensity-matched method during the same period. Those patients were stratified into three tertiles according to SYNTAX score and EuroSCORE. We compared major adverse cardiac and cerebrovascular events (MACCE include death, myocardial infarction, stroke or target vessel revascularization) and cost-effectiveness during follow-up among the patients. Continuous data are expressed as mean±standard deviation and categoric data as frequency and percentage. Mean values of continuous variables were compared by using the Student t test for variables that were not normal distribution and the Wilcoxon rank sum tests for variables that were not normal distributed. Categoric variables were compared using the chi-square test between groups. The Fisher exact and the Mann-Whitney tests were used when appropriate. Kaplan-Meier methodology was used to calculate actuarial freedom from endpoints. A p value of less than0.05was considered statistically significant.Results:The clinical and angiographic baseline characteristics were similar between the three groups. According to the results of coronary artery angiography, all patients in three groups have left anterior descending artery disease. At a mean follow-up of3.1years, hybrid was associated with similar rates of MACCE for patients with multivessel disease compared with CABG, but was significantly lower than PCI. The rates of MACCE were similar among patients with low and medium EuroSCOR. But in comparison with CABG and PCI, patients with high EuroSCORE who underwent hybrid had lower rates of MACCE (p=0.02and p=0.01). Hybrid was associated with similar rates of MACCE compared with CABG in each risk tertile of SYNTAX score. Compared with PCI according to SYNTAX score category, hybrid had similar rates of MACCE in low and medium tertile (p=0.34and p=0.13) but significantly lower in high risk tertile (p=0.004). The results of cost-effectiveness showed that treatment costs in hospital of hybrid were higher than CABG, but lower than PCI. At1year, hybrid was associated with lower additional direct costs per patient compared with CABG and PCI.Conclusions:1. The outcomes of one stop hybrid procedure were similar with CABG; in EuroSCORE high-risk group, it clinical outcomes were better than conventional CABG.2. Compared with PCI, one stop hybrid procedure significantly reduced MACCE incidence, and in EuroSCORE and SYNTAX score high-risk group, it's mid-term clinical effect was obviously better.3. one stop hybrid procedure consumed more resources in hospital than CABG, but the cost-effectiveness were similar in mid-term; one stop hybrid coronary revascularization procedure consumed less resources in hospital and in mid-term than PCI. Background:The clinical outcomes for multivessel coronary artery disease between hybrid coronary revascularization (HCR) and off-pump coronary artery bypass grafting (OPCAB) are still controversial.Objective:The present study was to make a meta-analysis of all current available studies which compare HCR with OPCAB for and assess was safety and efficacy between HCR and OPCAB for multivessel coronary disease.Methods:Electronic databases PubMed,EMBASE,Cochrane library and abstract of AHA,ACC,ESC,AATS,EACS were systematically searched. All researches which compared the clinical outcome between hybrid and OPCAB were included in the present study. The search period varied from April1996to December2010. The endpoint includes (1) death, myocardial infarction, cerebravascular event; target vessel repeated revascularization within30days,(2) MACCE (death,myocardial infarction, cerebravascular event; target vessel repeated revascularization) events during one year follow-up.Results:Eight studies with5,479patients were finally involved in the present study. The mortality was similar in hybrid and OPCAB groups at30days [odds ratio (95%confidence interval):0.88(0.31-2.55), P=0.82], and one year [0.23(0.05-1.06), P=0.06]. No significant difference was found between hybrid and OPCAB in the risk of MACCE at30days after surgery and during1year's follow up [30days, 1.35(0.33-1.29) P=0.06; one year,0.33(0.11-1.01) P=0.052].Conclusion:Our meta-analysis demonstrated that there were no significant differences in the safety between hybrid coronary revascularization and off-pump coronary artery bypass grafting in patients with multivessel coronary disease in the one year after intervention.