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

John D. Puskas, Michael E. Halkos, Joseph DeRose, Emilia Bagiella, Marissa A. Miller, Jessica Overbey, Johannes Bonatti, V. S. Srinivas, Mark Vesely, Francis Sutter, Janine Lynch, Katherine Kirkwood, Timothy A. Shapiro, Konstantinos D. Boudoulas, Juan Crestanello, Thomas Gehrig, Peter Smith, Michael Ragosta, Steven J. Hoff, David ZhaoAnnetine C. Gelijns, Wilson Y. Szeto, Giora Weisz, Michael Argenziano, Thomas Vassiliades, Henry Liberman, William Matthai, Deborah D. Ascheim

Research output: Contribution to journalArticle

41 Citations (Scopus)

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)

Original languageEnglish (US)
Pages (from-to)356-365
Number of pages10
JournalJournal of the American College of Cardiology
Volume68
Issue number4
DOIs
StatePublished - Jul 26 2016

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Multicenter Studies
Observational Studies
Percutaneous Coronary Intervention
Coronary Artery Disease
Arteries
Stroke
Taxus
Propensity Score
Proportional Hazards Models
Coronary Artery Bypass
Thoracic Surgery
Pathologic Constriction
Myocardial Infarction

Keywords

  • coronary artery bypass
  • coronary vessels
  • drug-eluting stents
  • follow-up studies
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease : A Multicenter Observational Study. / Puskas, John D.; Halkos, Michael E.; DeRose, Joseph; 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.

In: Journal of the American College of Cardiology, Vol. 68, No. 4, 26.07.2016, p. 356-365.

Research output: Contribution to journalArticle

Puskas, JD, Halkos, ME, DeRose, J, Bagiella, E, Miller, MA, Overbey, J, Bonatti, J, Srinivas, VS, Vesely, M, Sutter, F, Lynch, J, Kirkwood, K, Shapiro, TA, Boudoulas, KD, Crestanello, J, Gehrig, T, Smith, P, Ragosta, M, Hoff, SJ, Zhao, D, Gelijns, AC, Szeto, WY, Weisz, G, Argenziano, M, Vassiliades, T, Liberman, H, Matthai, W & Ascheim, DD 2016, 'Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease: A Multicenter Observational Study', Journal of the American College of Cardiology, vol. 68, no. 4, pp. 356-365. https://doi.org/10.1016/j.jacc.2016.05.032
Puskas, John D. ; Halkos, Michael E. ; DeRose, Joseph ; 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. / Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease : A Multicenter Observational Study. In: Journal of the American College of Cardiology. 2016 ; Vol. 68, No. 4. pp. 356-365.
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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)",
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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

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.

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. (Hybrid Revascularization Observational Study; NCT01121263)

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. (Hybrid Revascularization Observational Study; NCT01121263)

KW - coronary artery bypass

KW - coronary vessels

KW - drug-eluting stents

KW - follow-up studies

KW - percutaneous coronary intervention

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