Hybrid Revascularisation by Combined Coronary Artery Bypass Graft (CABG) and PCI in Multivessel Coronary Disease (HYBRID)
The present study is designed as a prospective, single centre, open label, observational trial.
The study will collect information about the medical care patients receive during their planned procedure(s). No new testing or procedures will be done.
Patients elected for hybrid revascularization will be asked their written consent to the use of their personal data.
Left internal mammary artery to the Left Anterior Descending Coronary Artery (LIMA-LAD)surgical revascularization will be performed first, followed by percutaneous revascularization of the other vessels in the frame of the same hospitalization.
After discharge patients will attend clinic visits at 30 days and 12 months, as per usual clinical practice, and will be contacted by phone at 6 months after procedure. Angiographic follow-up will be performed in symptomatic patients, as clinically indicated.
Coronary Artery Disease (CAD)
Procedure: LIMA-LAD surgical revascularization
|Study Design:||Observational Model: Case-Only
Time Perspective: Prospective
|Official Title:||Hybrid Revascularisation by Combined CABG and PCI in Multivessel Coronary Disease. An Observational Study.|
- composite of major cardiac and cerebrovascular events (MACCE) [ Time Frame: From date of inclusion until the date of first documented MACCE, assessed up to 12 months ] [ Designated as safety issue: Yes ]
composite of major cardiac and cerebrovascular events, i.e. the first occurrence of any of the following events:
Death from any cause
- From cardiovascular causes
- From noncardiovascular causes
- hospitalization for repeat revascularization procedure
- • Procedural success [ Time Frame: during index hospitalization up to discharge from the hospital ( expected average of hospital stay: 2 weeks) ] [ Designated as safety issue: Yes ]successful treatment will be declared when a complete hybrid revascularisation in the absence of complications during the index hospitalization has been achieved.
- • Procedural and post-procedural blood loss and number of transfusions [ Time Frame: during index hospitalization up to discharge from the hospital ( expected average of hospital stay: 2 weeks) ] [ Designated as safety issue: Yes ]
- • Recovery time [ Time Frame: from end of intervention up to discharge from the hospital (expected average of hospital stay: 2 weeks) ] [ Designated as safety issue: Yes ]time to extubation; number of days in ICU; total duration of hospital admission
- • New York Heart Association (NYHA) class modification with respect to baseline [ Time Frame: at 12 months post-procedure ] [ Designated as safety issue: No ]
- Quality of life (SF-12 questionnaire) [ Time Frame: at 12 months post-procedure ] [ Designated as safety issue: No ]
- Length of time to return to work or normal activities [ Time Frame: from hospital discharge (index hospitalization) up to date of return to work or normal activities assessed up to 12 months after intervention ] [ Designated as safety issue: No ]
|Study Start Date:||September 2011|
|Study Completion Date:||April 2016|
|Primary Completion Date:||April 2016 (Final data collection date for primary outcome measure)|
Patients with multi-vessel coronary artery disease (CAD) amenable to hybrid revascularization (LIMA-LAD surgical revascularization followed by PCI)
Procedure: LIMA-LAD surgical revascularization
Off-pump coronary artery bypass (OPCAB) in which coronary revascularization is performed on the beating heart will be followed, the choice of the technical solutions being left at the discretion of the cardiac surgeon:
State of the art drug eluting stent (DES)-based percutaneous coronary intervention will be used by each participating site, according to current international guidelines.
Zotarolimus, everolimus or sirolimus drug-eluting stents will be used in all sites.
Hybrid coronary revascularization integrates the positive features of both Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG), combining the durability of Left Anterior Descending Coronary Artery (LIMA) coronary bypass with the minimal invasiveness and lower risk of percutaneous intervention. Thereby it might represent a better option in a sizeable proportion of patients.
Candidate patients in whom hybrid revascularization would be advantageous are several subgroups of Coronary Artery Disease (CAD) patients that are increasing in numbers: the elderly patients with a high risk of mortality and/or morbidity for CABG, patients with significant disabilities and patients in whom treatment durability is important but a significantly invasive approach is not an option.
There are several potential advantages of the hybrid procedure over conventional CABG in selected patients. These advantages include the avoidance of cardiopulmonary bypass-related morbidity, no aortic manipulation with the LIMA-LAD with the beating heart procedure, less blood loss and decreased transfusions, a shorter recovery time than after conventional CABG and patient's preference for "minimally invasive" surgery.
The investigators hypothesize that in selected patients with diffuse coronary disease, a "hybrid" approach employing a staged revascularisation procedure may allow to lower the surgical risk, increase the completeness and effectiveness of revascularisation and, hopefully, to improve immediate and long term outcome.
To test this hypothesis, a well designed, properly sized, prospective, randomized study is needed. Available data, however, do not provide sufficient information to speculate on a clinically meaningful, yet achievable, effectiveness.
Aim of this observational study is therefore to collect more information on the target population, the clinical outcomes and optimal management in order to inform the design of a comparative effectiveness trial.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01443754
|Maria Cecilia Hospital|
|Cotignola, Ravenna, Italy, 48010|
|Principal Investigator:||Mauro Del Giglio, MD||GVM Care&Research|