TY - JOUR
T1 - Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease
T2 - A Multicenter Observational Study
AU - Puskas, John D.
AU - Halkos, Michael E.
AU - DeRose, Joseph J.
AU - Bagiella, Emilia
AU - Miller, Marissa A.
AU - Overbey, Jessica
AU - Bonatti, Johannes
AU - Srinivas, V. S.
AU - Vesely, Mark
AU - Sutter, Francis
AU - Lynch, Janine
AU - Kirkwood, Katherine
AU - Shapiro, Timothy A.
AU - Boudoulas, Konstantinos D.
AU - Crestanello, Juan
AU - Gehrig, Thomas
AU - Smith, Peter
AU - Ragosta, Michael
AU - Hoff, Steven J.
AU - Zhao, David
AU - Gelijns, Annetine C.
AU - Szeto, Wilson Y.
AU - Weisz, Giora
AU - Argenziano, Michael
AU - Vassiliades, Thomas
AU - Liberman, Henry
AU - Matthai, William
AU - Ascheim, Deborah D.
N1 - Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/7/26
Y1 - 2016/7/26
N2 - 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.
AB - 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.
KW - coronary artery bypass
KW - coronary vessels
KW - drug-eluting stents
KW - follow-up studies
KW - percutaneous coronary intervention
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U2 - 10.1016/j.jacc.2016.05.032
DO - 10.1016/j.jacc.2016.05.032
M3 - Article
C2 - 27443431
AN - SCOPUS:84990889412
SN - 0735-1097
VL - 68
SP - 356
EP - 365
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -
