Mid-Term and Long-Term Mortality Following Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting: A Meta-Analysis

Background:While numerous meta-analyses have explored the outcomes of various coronary revascularization strategies, the majority of existing literature predominantly concentrates on short-term results. Recognizing the limited focus on mid- and long-term outcomes, this meta-analysis aims to contribute to the understanding of the comparative effectiveness of hybrid coronary revascularization (HCR) and off-pump coronary artery bypass (OPCAB) procedures in these extended timeframes.Methods:A systematic literature review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted across multiple databases, including OVID MEDLINE®, EMBASE, SCOPUS, and PUBMED, up to January 2024. Inclusion criteria focused on studies reporting mid-term mortality (>1 year and <5 years) and/or long-term mortality (≥5 years) in patients undergoing HCR or OPCAB. Statistical analysis included hazard ratios (HRs) with 95% confidence intervals (CIs) using a random-effects model, assessment of heterogeneity with I2 statistics, and publication bias evaluation via funnel plot asymmetry.Results:Nine studies reported mid-term mortality (>1 year and <5 years) and five studies reported long-term mortality (≥5 years), including a total of 10,729 patients. The demographic characteristics of the patients showed no significant differences between the two intervention groups. There was no significant difference in mid-term mortality (HR: 0.94, 95% CI: 0.79–1.13, p = 0.52) and no significant difference in the long-term mortality (HR: 0.71, 95% CI: 0.41–1.23, p = 0.22).Conclusion:HCR demonstrated comparable mid-term and long-term mortality to OPCAB, suggesting similar sustained clinical efficacy between the two interventions. These findings have potential implications for clinical decision-making in cardiovascular care. However, it is crucial to acknowledge the limitations of this study, including potential biases in the included studies and constraints in the available data. Further research is warranted to validate and refine these results, considering the dynamic landscape of cardiovascular care.