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

• Type of Material: Article
• Authors: John D. Puskas, Icahn School of Medicine at Mount Sinai; Michael Halkos, Emory University; Joseph J. DeRose, Montefiore-Einstein Heart Center; Emilia Bagiella, Icahn School of Medicine at Mount Sinai; Marissa A. Miller, National Heart, Lung, and Blood Institute; Jessica Overbey, Icahn School of Medicine at Mount Sinai; Johannes Bonatti, Cleveland Clin Abu Dhabi; V.S. Srinivas, Montefiore-Einstein Heart Center; Mark Vesely, University of Maryland; Francis Sutter, Lankenau Hospital; Janine Lynch, Ohio State University; Katherine Kirkwood, Icahn School of Medicine at Mount Sinai; Timothy A. Shapiro, Lankenau Hospital; Konstantinos Boudoulas, Ohio State University; Juan Crestanello, Ohio State University; Thomas Gehrig, Duke University; Peter Smith, Duke University; Michael Ragosta, University of Virginia; Steven J. Hoff, Vanderbilt Heart Institute; David Zhao, Wake Forest University; Annetine C. Gelijns, Icahn School of Medicine at Mount Sinai; Wilson Y. Szeto, University of Pennsylvania; Giora Weisz, Columbia University; Michael Argenziano, Columbia University; Thomas Vassiliades, Emory University; Henry Liberman, Emory University; William Matthai, University of Pennsylvania; Deborah D. Ascheim, Icahn School of Medicine at Mount Sinai
• Language: English
• Date: 2016-07-26
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 American College of Cardiology Foundation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2016.05.032
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 68
• Issue: 4
• Start Page: 356
• End Page: 365
• Grant/Funding Information: National Institutes of Health and National Heart, Lung, and Blood Institutes grant 1-RC1-HL100951 to Drs. Puskas and Ascheim funded this study.
• Keywords: coronary artery bypass; Life Sciences & Biomedicine; INFARCTION; Science & Technology; BYPASS GRAFT-SURGERY; TRIAL; Cardiac & Cardiovascular Systems; RISK; ELUTING STENTS; DECREASE; follow-up studies; percutaneous coronary intervention; STENOSIS; drug-eluting stents; STRATEGIES; Cardiovascular System & Cardiology; coronary vessels
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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)