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Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease: A Multicenter Observational Study

Journal of the American College of Cardiology, 2016-07, Vol.68 (4), p.356-365 [Peer Reviewed Journal]

Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Jul 26, 2016 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2016.05.032 ;PMID: 27443431

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Title:
Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease: A Multicenter Observational Study
Author: Puskas, John D ; Halkos, Michael E ; DeRose, Joseph J ; Bagiella, Emilia ; Miller, Marissa A ; Overbey, Jessica ; Bonatti, Johannes ; Srinivas, V S ; Vesely, Mark ; Sutter, Francis ; Lynch, Janine ; Kirkwood, Katherine ; Shapiro, Timothy A ; Boudoulas, Konstantinos D ; Crestanello, Juan ; Gehrig, Thomas ; Smith, Peter ; Ragosta, Michael ; Hoff, Steven J ; Zhao, David ; Gelijns, Annetine C ; Szeto, Wilson Y ; Weisz, Giora ; Argenziano, Michael ; Vassiliades, Thomas ; Liberman, Henry ; Matthai, William ; Ascheim, Deborah D
Subjects: Cardiovascular disease ; Confidence intervals ; Coronary Angiography ; Coronary Artery Bypass - methods ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - surgery ; Coronary vessels ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - surgery ; Diabetes ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Heart attacks ; Heart surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures - methods ; Ostomy ; Percutaneous Coronary Intervention - methods ; Prospective Studies ; Robotics ; Stents ; Stroke ; Taxus ; Time Factors ; Treatment Outcome
Is Part Of: Journal of the American College of Cardiology, 2016-07, Vol.68 (4), p.356-365
Description: Hybrid coronary revascularization (HCR) combines minimally invasive surgical coronary artery bypass grafting of the left anterior descending artery with percutaneous coronary intervention (PCI) of non-left anterior descending vessels. HCR is increasingly used to treat multivessel coronary artery disease that includes stenoses in the proximal left anterior descending artery and at least 1 other vessel, but its effectiveness has not been rigorously evaluated. This National Institutes of Health-funded, multicenter, observational study was conducted to explore the characteristics and outcomes of patients undergoing clinically indicated HCR and multivessel PCI for hybrid-eligible coronary artery disease, to inform the design of a confirmatory comparative effectiveness trial. Over 18 months, 200 HCR and 98 multivessel PCI patients were enrolled at 11 sites. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) (i.e., death, stroke, myocardial infarction, repeat revascularization) within 12 months post-intervention. Cox proportional hazards models were used to model time to first MACCE event. Propensity scores were used to balance the groups. Mean age was 64.2 ± 11.5 years, 25.5% of patients were female, 38.6% were diabetic, and 4.7% had previous stroke. Thirty-eight percent had 3-vessel coronary artery disease, and the mean SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score was 19.7 ± 9.6. Adjusted for baseline risk, MACCE rates were similar between groups within 12 months post-intervention (hazard ratio [HR]: 1.063; p = 0.80) and during a median 17.6 months of follow-up (HR: 0.868; p = 0.53). These observational data from this first multicenter study of HCR suggest that there is no significant difference in MACCE rates over 12 months between patients treated with multivessel PCI or HCR, an emerging modality. A randomized trial with long-term outcomes is needed to definitively compare the effectiveness of these 2 revascularization strategies. (Hybrid Revascularization Observational Study; NCT01121263).
Publisher: United States: Elsevier Limited
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2016.05.032
PMID: 27443431
Source: GFMER Free Medical Journals
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Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease: A Multicenter Observational Study

Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Jul 26, 2016 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2016.05.032 ;PMID: 27443431

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