Long-term safety and effectiveness of hybrid coronary revascularization compared to conventional revascularization strategies: a systematic review and meta-analysis

Background: Hybrid coronary revascularization (HCR), a combination of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), is an emerging treatment for patients with multivessel coronary artery disease (MVCAD). While traditional CABG is considered the standard, HCR may mitigate issues like saphenous vein graft failure. Methods: We systematically searched PubMed, Scopus, Web of Science, and Embase until September 2024, targeting randomized controlled trials (RCTs) that evaluated HCR against CABG in MVCAD patients. The quality of included studies was assessed using the ROB2 tool, and data were analyzed using RevMan 5.4. Four RCTs (n = 382) involving 382 participants were analyzed using a random-effects model. Risk of bias was assessed using the ROB2 tool. Results: Four RCTs (n = 382) met inclusion criteria. At 30 days, there were no statistically significant differences between HCR and CABG in all-cause death (RR = 1.35, p = 0.74), stroke (RR = 0.99, p = 0.99), myocardial infarction (RR = 1.17, p = 0.74), or blood transfusion (RR = 0.70, p = 0.14), with zero heterogeneity (I 2 = 0%). At one-year follow-up, pooled analyses showed no significant differences in all-cause death (RR = 1.37, p = 0.62) or myocardial infarction (RR = 1.29, p = 0.56), also with consistent homogeneity (I 2 = 0%). Conclusion: HCR demonstrates comparable safety and effectiveness to CABG for MVCAD, with similar rates of key outcomes at both 30 days and one year. Further research with larger samples and longer follow-up is recommended to confirm these findings