title: Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease: A Multicenter Observational Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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).
authors.affiliation: Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai Cardiovascular Institute, New York, New York; Mount Sinai Heart at Mount Sinai Beth Israel, New York, New York. Electronic address: john.puskas@mountsinai.org.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Halkos
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Montefiore-Einstein Heart Center, Bronx, New York.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DeRose
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Emilia
authors.initials: E
authors.lastname: Bagiella
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Marissa A
authors.initials: MA
authors.lastname: Miller
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jessica
authors.initials: J
authors.lastname: Overbey
authors.affiliation: Department of Cardiothoracic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Montefiore-Einstein Heart Center, Bronx, New York.
authors.forename: V S
authors.initials: VS
authors.lastname: Srinivas
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland, Baltimore, Maryland.
authors.forename: Mark
authors.initials: M
authors.lastname: Vesely
authors.affiliation: Lankenau Hospital, Philadelphia, Pennsylvania.
authors.forename: Francis
authors.initials: F
authors.lastname: Sutter
authors.affiliation: Ohio State University, Columbus, Ohio.
authors.forename: Janine
authors.initials: J
authors.lastname: Lynch
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Katherine
authors.initials: K
authors.lastname: Kirkwood
authors.affiliation: Lankenau Hospital, Philadelphia, Pennsylvania.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Shapiro
authors.affiliation: Ohio State University, Columbus, Ohio.
authors.forename: Konstantinos D
authors.initials: KD
authors.lastname: Boudoulas
authors.affiliation: Ohio State University, Columbus, Ohio.
authors.forename: Juan
authors.initials: J
authors.lastname: Crestanello
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gehrig
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: Peter
authors.initials: P
authors.lastname: Smith
authors.affiliation: University of Virginia, Charlottesville, Virginia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ragosta
authors.affiliation: Vanderbilt Heart Institute, Nashville, Tennessee.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hoff
authors.affiliation: Wake Forest University, Winston-Salem, North Carolina.
authors.forename: David
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Annetine C
authors.initials: AC
authors.lastname: Gelijns
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Columbia University, New York, New York.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: Columbia University, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.affiliation: Emory University, Atlanta, Georgia; Medtronic, Inc., Fridley, Minnesota.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vassiliades
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Henry
authors.initials: H
authors.lastname: Liberman
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: William
authors.initials: W
authors.lastname: Matthai
authors.affiliation: Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai Cardiovascular Institute, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Deborah D
authors.initials: DD
authors.lastname: Ascheim
mesh_terms: D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery bypass; coronary vessels; drug-eluting stents; follow-up studies; percutaneous coronary intervention