Navigation Links
Results released for first multicenter study of hybrid revascularization
Date:3/10/2013

The first multicenter study of hybrid revascularization shows that the emerging procedure for treating coronary artery disease has a similar rate of major adverse events in the first year, compared with percutaneous intervention (stenting).

Hybrid revascularization is a minimally invasive blend of coronary bypass surgery and stenting. It has been described as a "best of both worlds" strategy for treating multi-vessel coronary artery disease. Surgeons avoid opening the patient's sternum, which facilitates recovery, while keeping the durability of bypass surgery for the most important of the blocked coronary arteries.

John Puskas, MD, professor of surgery and associate chief of cardiothoracic surgery at Emory University School of Medicine, was national principal investigator for the study and is scheduled to present the results at the American College of Cardiology meeting in San Francisco.

Participating institutions included: Brigham and Women's, Columbia, Duke, Emory, Lankenau Hospital (Pennsylvania), Montefiore-Einstein Heart Center, Ohio State, University of Maryland, University of Pennsylvania, University of Virginia and Vanderbilt. The data coordinating center was housed in the Department of Health Evidence & Policy at the Icahn School of Medicine at Mount Sinai in New York. The study was funded by a Challenge grant part of the 2009 American Recovery & Reinvestment Act from the National Heart, Lung and Blood Institute, and was conducted in association with the NHLBI Cardiothoracic Surgery Trials Network.

The study was a prospective cohort study that enrolled 200 hybrid patients and 98 patients who would have been eligible for a hybrid procedure, but had multi-vessel percutaneous intervention (PCI) instead.

"We started by taking a snapshot of each participating center's catheterization lab over three months," Puskas says. "That was over 6,500 patients, but only a fraction were eligible. They had to have a pattern of coronary artery disease that could be reasonably treated with either hybrid techniques or multivessel percutaneous intervention: both an LAD (left anterior descending) lesion and a significant stenosis in at least one other non-LAD coronary artery. This was a group of patients with low to medium complexity coronary artery disease."

The primary measure of safety was the rate of major adverse coronary and cerebrovascular events (MACCE: includes death, heart attack, stroke or repeat revascularization procedure). Over the first year, hybrid patients had a MACCE rate of 11 percent (0.143 events per patient-year) while PCI patients had a rate of 10 percent (0.119 events per patient year), with hybrid revascularization displaying a trend toward a MACCE rate lower than PCI after the first year. Patients were followed for up to an average of 17.5 months and over that time, the MACCE rate for hybrid revascularization patients was 0.868 times that for PCI patients, adjusted for baseline risk.

"A question this study starts to address is, whether short-term outcomes and complications over the first year are comparable between these two alternative therapies," Puskas says. "These results suggest that hybrid revascularization is as safe in the first year, with a trend to benefit over the longer term. It would be a challenge to markedly out-perform PCI over the first year we expect that if hybrid revascularization has an advantage, it will come out over the next few years."

He explains that multivessel coronary bypass surgery usually includes a left internal mammary artery (LIMA) graft for the blockage in the left anterior descending coronary artery (LAD), along with veins from the legs for the other blocked vessel(s). The LIMA graft has several advantages: most importantly, the LIMA graft stays open longer than vein grafts, because the LIMA is conditioned to higher blood pressures.

"We know the left internal mammary artery graft is the most durable treatment for that [LAD] blockage, so we expect there will be fewer repeat revascularizations in the hybrid group of patients," he says.

Hybrid revascularization keeps the LIMA graft for the LAD while using coronary stents for other non-LAD blockages, allowing a minimally invasive approach and avoiding use of the heart-lung machine.

"In light of the growing adoption of this treatment paradigm, a randomized trial of hybrid revascularization is now needed to rigorously evaluate its safety and efficacy relative to PCI," says Deborah D. Ascheim, MD, associate professor of health evidence & policy and cardiology at the Icahn School of Medicine at Mount Sinai, and principal investigator of the study's data coordinating center,

The results of the current study, Puskas agrees, support the Hybrid Observational Study Investigators' plans to conduct such a trial.


'/>"/>

Contact: Quinn Eastman
qeastma@emory.edu
404-727-7829
Emory Health Sciences
Source:Eurekalert

Related medicine news :

1. False-Positive Mammogram Results May Turn Out Not to Be: Study
2. Good intentions bring mixed results for Haitis disabled people
3. Presentation of 1-year IVAN and 2-year CATT study results
4. Groundbreaking Nigeria summit results in major commitment to reduce child deaths
5. Surprising results for use of dialysis for kidney failure in developing world
6. Stem Cell Study Shows Promising Results Against Heart Failure
7. Automated insulin dosage titration system demonstrates positive clinical study results
8. Quality of care, other issues may cause worse results in black prostate cancer surgery patients
9. Tight Blood-Sugar Control Shows Mixed Results for Health of Kidneys: Study
10. ACP-New York State Chapter partnership results in patient safety organization recognition
11. Long-term testosterone treatment for men results in reduced weight and waist size
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/27/2017)... ... February 27, 2017 , ... POUGHKEEPSIE, N. Y. – Peer-reviewed guidelines from the ... studies, the Center for Disease Control ( CDC ) and Infectious Diseases Society of ... Liegner, M.D. has compiled into a single volume a compelling argument that the disease ...
(Date:2/27/2017)... ... February 27, 2017 , ... New Jersey ranks among the top five ... genders. And the need for advanced services is growing. , Project WE vs ... program, in collaboration with their non-profit partners in their fight against cancer and in ...
(Date:2/26/2017)... ... February 26, 2017 , ... LatitudeC Baby Products, ... today announced it would be offering some it’s exclusive product line to the ... quality and unique baby clothing/feeding products, will team up with AMAZON to distribute ...
(Date:2/26/2017)... (PRWEB) , ... February 26, 2017 , ... ... Parkinson’s disease (PD) in persons with a specific LRRK2 mutation, according to a ... , Previous studies have provided evidence of a link between pesticides and incidence ...
(Date:2/24/2017)... NJ (PRWEB) , ... February 24, 2017 , ... ... that provides business development, education, networking and recognition opportunities as well as advocacy ... Bell Works in Holmdel, NJ on February 23. The Council's Innovation Forecast ...
Breaking Medicine News(10 mins):
(Date:2/27/2017)... 27, 2017 Leading Countries, Technologies and Companies ... expected to grow at a CAGR of 8.9% from 2016-2021 and ... at a CAGR of 9.1% from 2016 to 2027. The market ... ... benefit you Read on to discover how you can exploit ...
(Date:2/27/2017)... and PETACH TIKVAH, Israel , Feb. ... BCLI), a leading developer of adult stem cell technologies ... June S. Almenoff , M.D., Ph.D., FACP, and ... of Directors.  "Dr. Almenoff and Mr. ... come at an exciting time for our company," said ...
(Date:2/27/2017)... Feb 27, 2017 The Dutch ... NATO for use at the security level RESTRICTED. The solution ... NATO organization for the communication of classified information. ... Sectra and Samsung ... an eavesdrop-secure smartphone solution. Sectra Tiger/R is developed by Sectra ...
Breaking Medicine Technology: