Author + information
- Received March 28, 2016
- Accepted May 2, 2016
- Published online July 26, 2016.
- John D. Puskas, MDa,b,∗ (, )
- Michael E. Halkos, MDc,
- Joseph J. DeRose, MDd,
- Emilia Bagiella, PhDe,
- Marissa A. Miller, DMV, MPHf,
- Jessica Overbey, MSe,
- Johannes Bonatti, MDg,
- V.S. Srinivas, MDd,
- Mark Vesely, MDh,
- Francis Sutter, MDi,
- Janine Lynch, MPHj,
- Katherine Kirkwood, MSe,
- Timothy A. Shapiro, MDi,
- Konstantinos D. Boudoulas, MDj,
- Juan Crestanello, MDj,
- Thomas Gehrig, MDk,
- Peter Smith, MDk,
- Michael Ragosta, MDl,
- Steven J. Hoff, MDm,
- David Zhao, MDn,
- Annetine C. Gelijns, PhDe,
- Wilson Y. Szeto, MDo,
- Giora Weisz, MDp,
- Michael Argenziano, MDp,
- Thomas Vassiliades, MDc,q,
- Henry Liberman, MDc,
- William Matthai, MDo and
- Deborah D. Ascheim, MDa,e
- aDepartment of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai Cardiovascular Institute, New York, New York
- bMount Sinai Heart at Mount Sinai Beth Israel, New York, New York
- cEmory University, Atlanta, Georgia
- dDivision of Cardiothoracic Surgery, Department of Surgery, Montefiore-Einstein Heart Center, Bronx, New York
- eDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- fNational Heart, Lung, and Blood Institute, Bethesda, Maryland
- gDepartment of Cardiothoracic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- hDivision of Cardiothoracic Surgery, Department of Surgery, University of Maryland, Baltimore, Maryland
- iLankenau Hospital, Philadelphia, Pennsylvania
- jOhio State University, Columbus, Ohio
- kDuke University, Durham, North Carolina
- lUniversity of Virginia, Charlottesville, Virginia
- mVanderbilt Heart Institute, Nashville, Tennessee
- nWake Forest University, Winston-Salem, North Carolina
- oUniversity of Pennsylvania, Philadelphia, Pennsylvania
- pColumbia University, New York, New York
- qMedtronic, Inc., Fridley, Minnesota
- ↵∗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.
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)
- coronary artery bypass
- coronary vessels
- drug-eluting stents
- follow-up studies
- percutaneous coronary intervention
National Institutes of Health and National Heart, Lung, and Blood Institutes grant 1-RC1-HL100951 to Drs. Puskas and Ascheim funded this study. 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. Friedrich-Wilhelm Mohr, MD, PhD, served as Guest Editor for this paper.
- Received March 28, 2016.
- Accepted May 2, 2016.
- American College of Cardiology Foundation