Hybrid coronary revascularization versus coronary artery bypass: a metaanalysis
Wang Yuanyuana, Zhao Zhifangb, Liu Leia, Wu Yunjinga
2020, 35(1):
5-12.
doi:10.3969/j.issn.1004-583X.2020.01.001
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Objective To evaluate the efficacy and safety of coronary revascularization hybridization(HCR) and coronary artery bypass grafting(CABG) in the treatment of coronary heart disease. Methods Databases such as MEDLINE, EMBASE, CNKI, Corchrane library, combined with secondary resource, were searched with the key words being “hybridization, coronary artery bypass grafting, percutaneous coronary stent implantation, onestop coronary artery hybridization, and staged coronary artery hybridization”. The odd ratio (odd ratio, OR) and 95% confidence interval (95% confidence interval, CI) were adopted to evaluate the incidence of major cardiovascular events in HCR and CABG (mortality, incidence of stroke, incidence of myocardial infarction, target vascular revascularization(TVR), major cardio cerebral vascular events (MCCVEs) and the diference about the incidence of new atrial fibrillation and the rate of red blood cell infusion.The median difference(MD) and 95%CI were used to evaluate the difference between the length of mechanical ventilation time, the time of ICU and the time of total hospitalization. Statistical analysis was performed by RevMan 5.2 for heterogeneity test and Meta analysis. Results A total of 17 experiments met the criteria in the retrieved literature, totaling 8 608 patients. There was no significant difference between the mortality (OR=0.77, 95%CI［0.42, 1.41］, I2［0%］, P=0.39); the incidence of myocardial infarction (OR=0.78, 95%CI［0.40, 1.52］, I2［0%］, P=0.47); the incidence of stroke （OR=0.67, 95%CI［0.34，1.33］, I2［0%］, P＝0.26) and the incidence of major cardio cerebral vascular events（OR=0.74, 95%CI［0.53，1.03］, I2［0%］，P=0.07）; the rate of target vascular revascularization （OR=2.41, 95%CI［0.91，6.38］, I2［0%］，P=0.08） and the incidence of new atrial fibrillation（OR=0.92, 95%CI［0.70, 1.22］, I2［29%］, P=0.56） were not statistically different; The rate of cellular infusion （OR=-0.16, 95%CI［-0.22, -0.09］, I2［34%］，P＜0.01） decreased, and there were statistical differences. And, there were significant differences between mechanical ventilation time（OR=-6.25, 95%CI［-9.01，-5.32］, I2［22%］, P＜0.01）; ICU time（OR=-18.58, 95%CI［-23.65, -13.52］, I2［45%］, P＜0.01）, and total hospitalization time （OR=-0.3, 95%CI［-0.46, -0.15］, I2［6%］, P＜0.01）, and all the time was shortened, which was of great statistical significance.Conclusion It is clear that coronary artery revascularization is safe and feasible with advantages over CABG.