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Author Notes:

REPRINT REQUESTS AND CORRESPONDENCE: Dr. John D. Puskas, Department of Cardiovascular Surgery, Mount Sinai Beth Israel, 317 East 17th Street, 11th Floor, Fierman Hall, New York, New York 10003. john.puskas@mountsinai.org.

Friedrich-Wilhelm Mohr, MD, PhD, served as Guest Editor for this paper.

Dr. Halkos has served as a consultant to Intuitive Surgical and Medtronic. Dr. Sutter serves on the Speakers Bureau of Intuitive Surgical. Dr. Shapiro serves on the Speakers’ Bureau of Astra Zeneca; and serves as a consultant to Intuitive Surgical. Dr. Hoff serves as a peer trainer and consultant for Medtronic. Dr. Vassiliades is a full-time employee of Medtronic. All other authors have reported that they no relationships relevant to the contents of this paper to disclose.

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Research Funding:

National Institutes of Health and National Heart, Lung, and Blood Institutes grant 1-RC1-HL100951 to Drs. Puskas and Ascheim funded this study.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • coronary artery bypass
  • coronary vessels
  • drug-eluting stents
  • follow-up studies
  • percutaneous coronary intervention
  • BYPASS GRAFT-SURGERY
  • ELUTING STENTS
  • STENOSIS
  • STRATEGIES
  • INFARCTION
  • DECREASE
  • TRIAL
  • RISK

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

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Journal Title:

Journal of the American College of Cardiology

Volume:

Volume 68, Number 4

Publisher:

, Pages 356-365

Type of Work:

Article | Post-print: After Peer Review

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)

Copyright information:

© 2016 American College of Cardiology Foundation.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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