Hybrid Coronary Revascularization And Coronary Artery Bypass Gragting For Multivessel Coronary Artery Disease:a Meta-analysis

Background and Objective : With the improvement of the surgical operation and interventional therapy, the CAD mortalities had been reduced significantly in the past decades.But because of the major adverse coronary events such as myocardial infarction, heart failure and sudden death,CAD remained the leading cause of death worldwide. Multivessel coronary artery disease was one of the CAD which was difficult to treat and had a high risk,CABG was generally regarded as a preferred revascularization strategy.With the use of drug eluting stent in clinical treatment, PCI began to effect the leading position of CABG.But the research confirmed that,to multivessel coronary artery disease, the all-cause mortality, myocardial infarction and target vessel repeated revascularization in CABG group were superior to PCI group. Hybrid Coronary Revascularization was used in clinical increasingly which got the superiority of CABG and PCI,its safety was preliminary reflected.There was several studies for the availability and safety of HCR versus CABG for multivessel coronary artery disease.But they could not represent the overall population because of there high selectivity. This meta-analysis assessed the acailability and safety of HCR versus CABG for multivessel coronary artery disease.Methods: The data of Pub Med,EMbase,Cochrance Library were retrieved to search the studies which compared HCR and CABG for multivessel coronary artery disease.(The search period varied from 1996 to December 2014),and the reference in this selected studies was retrieved by hands at the same time.Then,we give a Meta-analysis by using Rev Man 5.2 software.Results: Nine studies including 2553 patients were enrolled into our meta-analysis.The result of meta-analysis showed as follows:compared with CABG,the renal injury and atrial fibrillation of HCR had no statistical difference,but the Mechanical ventilation,Intens ive care unit(ICU) and hospital stay were shorter obvious ly( WMD-5.44; 95%CI-8.70,-2.18; P=0.95;WMD-13.80;95%CI-24.44,-3.15;P=0.005;WMD-1.47;95%CI-2.77,-0.18;P<0.00001), simultaneously,fewer patients got blood transfusion and wound infection(RR0.54;95%CI 0.46,0.65;P=0.12;RR0.47;95%CI0.24,0.92;P=0.57).The target vessel repeated revascularization( TVR) was higher in HCR at 3 years(RR2.95;95%CI 1.70,5.11;P=0.51),no significant difference was found between HCR and OPCAB in the risk of other MACCE at 30 days,1 year and 3 years.Conclusion: The current limited evidences suggest that,there were no differences in the prognosis between HCR and CABG in the multivessel coronary artery disease.But HCR had shorter recovery time and fewer blood transfusion or wound infection.HCR could be a feasible alternative to CABG for some patients.However because of the limitation in the quantity and quality, more Multi-Center randomized trials were required.