Multivessel Coronary Artery Disease
Conditions
Keywords
Multivessel Coronary Artery Disease, Hybrid Revascularization
Brief summary
This is a pilot randomized study that aim to assess the safety and feasibility of a hybrid myocardial revascularization strategy (coronary artery by-pass graft and percutaneous intervention) in comparison with conventional surgical coronary bypass grafting.
Interventions
PROCEDUREHybrid Revascularization
Off-pump LIMA connected to the left anterior descending artery followed by percutaneous coronary intervention with drug eluting stents to the other territories.
PROCEDUREConventional Coronary Artery Bypass Surgery
On pump coronary artery by-pass surgery
Sponsors
Boston Scientific Corporation
InCor Heart Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Triple-vessel disease with proximal or mid LAD disease with angiographic diameter stenosis \> 70% by visual analysis in all three territories, requiring myocardial revascularization OR triple-vessel disease with proximal or mid LAD disease with angiographic diameter stenosis 50-70% by visual analysis in any territory but with invasive or non-invasive evidence of flow-limiting stenosis in all three territories, requiring myocardial revascularization * Total SYNTAX score \> 22 * LCx and RCA territories estimated to be equivalently revascularized by either PCI or CABG, with at least one major non-LAD vessel to be treated * Clinical and anatomic eligibility for both PCI and CABG as agreed to by both interventional and surgical consensus * Interventionalist determines PCI appropriateness and eligibility * Surgeon determines surgical appropriateness and eligibility * Silent ischemia, stable angina, unstable angina or recent MI * If recent MI, cardiac biomarkers must have returned to normal prior to randomization * Ability to sign informed consent and comply with all study procedures
Exclusion criteria
* Prior PCI or CABG at any time prior to randomization * Need for any concomitant cardiac surgery other than CABG (e.g. valve surgery, aortic repair, etc.), or intent that if the patient randomizes to surgery, any cardiac surgical procedure other than isolated CABG will be performed * Patients unable to tolerate, obtain or comply with dual antiplatelet therapy for at least one year * Patients requiring additional surgery (cardiac or non cardiac) within one year * The presence of any clinical or anatomical condition(s) which leads the participating interventional cardiologist to believe that clinical equipoise is not present (i.e. the patient should not be treated by PCI, but rather should be managed with CABG or medical therapy - reasons will be documented) * The presence of any clinical or anatomical condition(s) which leads the participating cardiac surgeon to believe that clinical equipoise is not present (i.e. the patient should not be treated by CABG, but rather should be managed with PCI. or medical therapy - reasons will be documented) * Non cardiac co-morbidities with life expectancy less than 1 year * Other investigational drug or device studies that have not reached their primary endpoint.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of Revascularization Procedure Proposed by the Heart Team | 30 days | The primary endpoint of this pilot study is the feasibility of revascularization planned preoperatively by the Heart team in the absence of adverse events (death, myocardial infarction, stroke, or unplanned revascularization) at 30 days. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Stent Thrombosis | 1 year | Evaluate stent thrombosis according to the ARC (Academic Research Consortium) criteria |
| Clinical and Angiographic Scores Correlation with Prognostic | 1 year | Evaluate the clinical correlation between the revascularization strategy and the usefulness of the SYNTAX score, ACEF score, clinical SYNTAX score, logistic EuroSCORE, STS score and InsCor for prognostic evaluation |
| Efficacy of the Strategy | 1 year | Evaluate and compare the rate of repeated revascularization (target lesions and target vessels) in each one of both strategies. |
| Symptomatic Graft Occlusion | 1 Year | Evaluate patients that presented with recurrent ischaemia symptoms due to graft occlusion. The diagnostic must be done by angiography or angiotomography. |
| Major Adverse Cardiovascular Events | 1 year | Composite and isolated measure of adverse events (all-cause death, myocardial infarction, stroke, or unplanned revascularization) at 1 year and annually up to 5 years. |
| Safety | 1 year | Cause of death (cardiac vs. non-cardiac); MI type; stroke type and severity. |
| Recurrence of Angina | 1 year | Analyse patient recurrence of angina according to the Canadian Cardiovascular Society (CCS) |
| Medication Impact | 1 year | Impact of antithrombotic agents and dual antiplatelet therapy in peri-procedural and long-term follow up safety end points. |
| Bleeding | 1 year | Hemorrhagic complications according to the BARC (Bleeding Academic Research Consortium) criteria |
| Neurological Events | 1 year | Evaluate neurological complications by clinical tests (physical examination), vascular ultrasound and doppler perfusion measures. |
| Graft Patency | 1 year | Patency of grafts and coronary artery disease at 1 year of follow-up evaluated by angiotomography |
Other
| Measure | Time frame | Description |
|---|---|---|
| Hospital Stay | 1 year | Evaluate and compare the period of hospital stay of the patients enrolled in each one of the strategies. |
| Quality of life. | 5 years | — |
| Cost | 5 years | Evaluate and compare the final cost of the procedure and follow up period of the patients enrolled in each one of the strategies. |
Countries
Brazil
Outcome results
None listed