HCR vs. CABG Study

Study Overview
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Brief Summary
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The purpose of the study is to find out if hybrid coronary revascularization (HCR) and coronary artery bypass grafting (CABG) procedure outcomes are similar. HCR is a combination of surgery and catheter procedures to open up clogged heart arteries. CABG is a surgical procedure to open up clogged heart arteries.

Detailed Description
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Currently, it is not clear how the outcomes of hybrid coronary revascularization (HCR) compare with other treatments. The purpose of the study is to find out if HCR and coronary artery bypass grafting (CABG) procedure outcomes are similar. HCR is a combination of surgery and catheter procedures to open up clogged heart arteries. CABG is a surgical procedure to open up clogged heart arteries. This study will collect information about the medical care participants receive during their planned procedure. No new testing or procedures will be done. Participants will have only the tests or procedures already planned by their doctor. The investigators will look at how well participants do after the procedure by assessing the outcomes of interest 30 days after surgery and, potentially, one year after surgery (funding dependent).

Official Title
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Hybrid Coronary Revascularization Versus Coronary Artery Bypass Surgery for Treatment of Multivessel Coronary Disease

Conditions
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Coronary Artery Disease

Intervention / Treatment
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* Procedure: Hybrid Coronary Revascularization (HCR)
* Procedure: Coronary Artery Bypass Grafting (CABG)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Able to give informed consent Have multi-vessel coronary artery disease (CAD) involving the Left Anterior Descending (LAD) artery Have a clinical indication for revascularization Are a candidate for either HCR or CABG or both Anatomy suitable for HCR shall include Multi-vessel CAD involving the LAD and/or LAD disease and involvement of a major diagonal artery, both of which require revascularization Exclusion Criteria: Prior cardiac operations Severe left ventricular dysfunction with ejection fraction (EF) < 30% Patients with chest radiation Body mass index (BMI) > 35 Severe peripheral vascular disease (PVD) Acute ischemia requiring emergent traditional coronary artery bypass graft (CABG)
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Hybrid Coronary Revascularization (HCR)<br>Patients who are scheduled to have the hybrid coronary revascularization (HCR) procedure for treatment of multi-vessel coronary artery disease. The treatment plan is determined by the patient's doctor. | Procedure: Hybrid Coronary Revascularization (HCR)<br>* Hybrid coronary revascularization (HCR) is a combination of surgery and catheter procedures to open up clogged heart arteries. HCR is the intentional combination of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The HCR strategy combines grafting of the left anterior descending artery (LAD) coronary artery using the left internal mammary artery (LIMA) with PCI of non-LAD coronary stenoses. Drug-eluting stents are substituted for saphenous vein grafts (SVG) for non-LAD coronary targets, and the surgical LIMA to LAD bypass is performed, ideally through a minimally invasive, limited access, sternal-sparing approach.<br>|
| Coronary Artery Bypass Grafting (CABG)<br>Patients who are scheduled to have the coronary artery bypass grafting (CABG) procedure for treatment of multi-vessel coronary artery disease. The treatment plan is determined by the patient's doctor. | Procedure: Coronary Artery Bypass Grafting (CABG)<br>* Coronary artery bypass grafting (CABG) is a surgery to create a new path for blood flow to the heart. A healthy section of vein or artery from elsewhere in the patient's body will be attached to the coronary artery just above and below the area of concern, to create a way for blood to bypass the blocked part of the coronary artery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of major adverse cardiac and cerebrovascular events (MACCE) between groups | Major adverse cardiac and cerebrovascular events (MACCE) will be assessed at 30 days and at one year after the index procedure. For the purpose of this trial, the components of MACCE include (1) all-cause mortality, (2) repeat revascularization, (3) stroke, and (4) myocardial infarction. | Up to one year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of all-cause mortality between groups | All-cause mortality will be assessed at 30 days and at one year after the index procedure. | Up to one year | 
| Comparison of repeat revascularization between groups | Repeat revascularization (all-cause) will be assessed at 30 days and at one year after the index procedure. | Up to one year | 
| Comparison of stroke between groups | The incidence and severity of strokes experienced between the groups will be assessed at 30 days and at one year after the index procedure, using the NIH Stroke Scale (NIHSS). The NIHSS is a 15-item neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. A trained observer rates the patent's ability to answer questions and perform activities. Ratings for each item are scored with 3 to 5 grades with 0 as normal, and there is an allowance for untestable items. The single patient assessment requires less than 10 minutes to complete. | Up to one year | 
| Comparison of ischemia-driven repeat revascularization between groups | The incidence of ischemia-driven revascularization experienced between the groups will be assessed at 30 days and at one year after the index procedure. | Up to one year | 
| Comparison of ventilator time between groups | The amount of time each patient spends on a ventilator during the index hospitalization will be collected. | During hospitalization (typically 3-8 days) | 
| Comparison of surgical re-exploration between groups | The incidence of re-exploration due to postoperative bleeding will be collected during the index hospitalization. | During hospitalization (typically 3-8 days) | 
| Comparison of chest tube drainage complications between groups | Chest tube drainage complications will be collected during the index hospitalization. | During hospitalization (typically 3-8 days) | 
| Comparison of hospital length of stay between groups | Hospital length of stay will be collected during the index hospitalization. | During hospitalization (typically 3-8 days) | 
| Comparison of wound infection between groups | The incidence of wound infection will be collected during the index hospitalization. | During hospitalization (typically 3-8 days) | 
| Comparison of atrial fibrillation between groups | The incidence of atrial fibrillation will be collected during the index hospitalization. | During hospitalization (typically 3-8 days) | 
| Comparison of blood transfusion between groups | The incidence of blood transfusions will be collected during the index hospitalization. | During hospitalization (typically 3-8 days) | 
| Comparison of hospital readmission between groups | Hospital readmission (all-cause and cardiac) will be assessed at 30 days and at one year after the index procedure. | Up to one year | 
| Comparison of Angina Score between groups | Angina will be assessed at Baseline (prior to surgery), 30 days after the procedure, and at one year after the index procedure. The Canadian Cardiovascular Society Angina Grading Scale will be used to categorize angina: Class I - Ordinary physical activity does not cause angina, such as walking and climbing stairs. Angina with strenuous or rapid or prolonged exertion at work or recreation Class II - Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, or in cold, or in wind, or under emotional stress or only during the few hours after awakening Class III - Marked limitation of ordinary physical activity. Walking one or two blocks on the level and climbing one flight of stairs in normal conditions and at normal pace Class IV - Inability to carry on a physical activity without discomfort - angina syndrome may be present at rest | Up to one year | 
| Comparison of Duke Activity Scale Index (DASI) scores between groups | The Duke Activity Scale Index (DASI) will be administered at Baseline (prior to surgery), 30 days after the procedure, and at one year after the index procedure. The DASI is a 12 item survey that asks about a patient's functional capacity in order to estimate peak oxygen uptake. Respondents answer yes or no to questions about their ability to do activities of different intensity levels. | Up to one year | 
| Comparison of EuroQol EQ-5D scores between groups | The EuroQol EQ-5D will be administered at Baseline (prior to surgery), 30 days after the procedure, and at one year after the index procedure. The EuroQol EQ-5D is a 6 item survey that asks about how a patient is feeling on the day of the survey in terms of mobility, self-care, usual activities, pain/discomfort, anxiety/depression, and how they rate their health on a scale of 0 to 100 (where 0 is the worst health imaginable and 100 is the best health imaginable). | Up to one year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Coronary Arteriosclerosis, Hybrid Coronary Revascularization, Coronary Artery Bypass Grafting