Hybrid Coronary Revascularization Versus Conventional Bypass Surgery: A Meta-Analysis

Introduction/Background: Hybrid coronary revascularization (HCR) combines minimally invasive surgical grafting of the left anterior descending artery with percutaneous coronary intervention of remaining vessels. Whether it offers outcomes comparable to conventional coronary artery bypass grafting (CABG) remains uncertain. Research Questions/Hypothesis: We hypothesized that HCR provides mortality, stroke, and major adverse cardiac and cerebrovascular event (MACCE) rates comparable to CABG, with a possible difference in repeat revascularization. Methods/Approach: We pooled propensity-score adjusted (matched or weighted) observational studies comparing HCR with CABG. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects models, and time-to-event outcomes were evaluated using hazard ratios (HR) directly extracted from the included studies. Heterogeneity was assessed by I 2 . Sensitivity (leave-one-out), subgroup (on-pump vs off-pump; multivessel vs left main), meta-regression (by SYNTAX score difference, for mortality), and funnel-plot analyses were performed. Results: Our meta-analysis included 29 propensity-score adjusted observational studies comprising 9,755 patients (HCR: 3,773; CABG: 5,368). Repeat revascularization (22 studies) was significantly higher with HCR (OR 1.75; 95% CI 1.40–2.18; P<0.001; I 2 =20.8%), robust on leave-one-out analysis. Stroke (14 studies) was lower with HCR (OR 0.69; 95% CI 0.49–0.98; P=0.040; I 2 =0%), though sensitive to individual studies on leave-one-out analysis. Across 24 studies there were no significant differences in all-cause mortality (OR 0.81; 95% CI 0.62–1.05; P=0.115; I 2 =44.2%). MACCE (17 studies) was similar (OR 0.98; 95% CI 0.71–1.34; P=0.896; I 2 =53.6%). Conclusions remained consistent on time-to-event analysis (repeat revascularization HR 1.88, 95% CI 1.47–2.41; mortality HR 0.93, 95% CI 0.66–1.31). By anatomical complexity (multivessel vs left main), no significant subgroup interactions were seen for mortality (P=0.643), MACCE (P=0.176), or stroke (P=0.452). By surgical technique (on-pump vs off-pump), no differences were seen for mortality (P=0.855) or repeat revascularization (P=0.780), whereas a significant interaction was observed for MACCE (P=0.0026), driven by a single on-pump study. Meta-regression showed baseline SYNTAX score differences did not significantly modify mortality, and funnel plots showed no major asymmetry. Conclusions: Compared with CABG, HCR showed comparable all-cause mortality and MACCE, lower stroke odds, and higher odds of repeat revascularization. Drawn from propensity-score adjusted observational data, these results suggest HCR is a reasonable alternative in selected patients but carries a greater need for repeat revascularization.