Breaking News
January 18, 2018 - A new strategy proposed for drug discovery
January 17, 2018 - Lactation May Lower T2D Risk in Younger Women
January 17, 2018 - New Atopic Dermatitis Yardstick provides practical guidance and management insights
January 17, 2018 - New biodegradable pressure sensor could help monitor serious health conditions
January 17, 2018 - HSS orders Sectra’s 3D pre-operative planning solution for improving patient outcomes
January 17, 2018 - Study identifies six new genes regions associated with diabetes
January 17, 2018 - Women do not receive timely diagnosis for heart disease
January 17, 2018 - AbbVie’s Upadacitinib Shows Positive Results as Monotherapy in Phase 3 Rheumatoid Arthritis Study, Meeting All Primary and Key Secondary Endpoints
January 17, 2018 - Should President Trump’s Physical Include a Cognitive Screen?
January 17, 2018 - Could gene therapy someday eliminate HIV?
January 17, 2018 - Researchers identify new anti-inflammatory drug target
January 17, 2018 - Loxo Oncology Initiates Rolling Submission of New Drug Application to U.S. Food and Drug Administration for Larotrectinib for the Treatment of TRK Fusion Cancers
January 17, 2018 - Trunk Imaging Tied to Higher Nephrectomy Risk
January 17, 2018 - Campaigners incensed at failings in Africa AIDS war
January 17, 2018 - Research opens door to development of new treatment for type 2 diabetes
January 17, 2018 - Bariatric surgery extends lifespan in obese patients, shows study
January 17, 2018 - Bristol-Myers Squibb Receives FDA Approval for Opdivo (nivolumab) as Adjuvant Therapy in Patients with Completely Resected Melanoma with Lymph Node Involvement or Metastatic Disease
January 17, 2018 - Ewww Moments in the ER: That’s Improbable!
January 17, 2018 - Methods from optogenetics, machine learning should help improve treatment options for stroke patients
January 17, 2018 - Booze may help or harm the heart, but income matters
January 17, 2018 - Three-dimensional organization of genome plays key role in gene expression, cell fate
January 17, 2018 - Scientists identify six new gene regions that may help treat type 1 diabetes
January 17, 2018 - Top nutrients needed to boost mood and energy levels on Blue Monday
January 17, 2018 - Scientists develop unique technique to map elasticity of cell components
January 17, 2018 - Obesity surgery reduces the risk of death by half finds new study
January 17, 2018 - Raw Meat Not the Safest Choice for Your Dog or for You
January 17, 2018 - Men who lack HSD17B4 gene may be more susceptible to treatment-resistant prostate cancer
January 17, 2018 - High-Dose Aspirin Preferred for Kawasaki’s
January 17, 2018 - Study suggests risk management approach to combat EMS fatigue
January 17, 2018 - A new therapy against obesity
January 17, 2018 - Doctors warn against holding your nose and closing your mouth to contain a sneeze
January 17, 2018 - Measles outbreak alarms public health officials
January 17, 2018 - FDA Slaps Class Warning on Gadolinium Contrast Agents
January 17, 2018 - Distinct human mutations can alter the effect of medicine
January 17, 2018 - ASIT biotech’s new article presents clinical results of gp
January 17, 2018 - Alternative tobacco use by adolescents associated with greater odds of future cigarette smoking
January 17, 2018 - A High-Salt Diet Produces Dementia In Mice
January 17, 2018 - Scientists provide insights into crucial interaction for DNA repair
January 17, 2018 - Sanofi and Regeneron Announce Positive Topline Pivotal Results for PD-1 Antibody Cemiplimab in Advanced Cutaneous Squamous Cell Carcinoma
January 17, 2018 - Morning Break: Pfizer Kills AD/PD Pipeline; Trump Affirms His Mental Health; Humira Pricing Strategy
January 17, 2018 - Researchers see gene influencing performance of sleep-deprived people
January 17, 2018 - Fast food triggers the immune system making it hyperactive
January 17, 2018 - Scientists find increased risk of HIV outbreaks in Ukraine due to war-related migration
January 17, 2018 - New universal flu vaccine moves to clinical trial phase and could be a reality soon
January 17, 2018 - Cocaine de-addiction breakthrough shows promise
January 17, 2018 - FDA Accepts New Drug Application for Seysara (sarecycline) for the Treatment of Moderate to Severe Acne
January 17, 2018 - Robotic Telestenting; BP Cuff Smartwatch; Medicare Bundled Care
January 17, 2018 - New cellular approach found to control progression of chronic kidney disease
January 17, 2018 - Lamprey genes provide clues to repair spinal cord damage, finds study
January 17, 2018 - Tissue-based soft robot could lead to advances in bio-inspired robotics
January 17, 2018 - Mostly the healthy and wealthy Americans use mobile phone apps to track sleep habits
January 17, 2018 - FDA Alert: Varubi (rolapitant) Injectable Emulsion: Health Care Provider Letter
January 16, 2018 - NeuroBreak: Rough Days for Neuroscience Research; Another Migraine Drug Advances
January 16, 2018 - The ‘greatest pandemic in history’ was 100 years ago – but many of us still get the basic facts wrong
January 16, 2018 - Serena Williams Shares Childbirth Ordeal
January 16, 2018 - The Artificial Brain as Doctor
January 16, 2018 - Type 2 diabetes has hepatic origins
January 16, 2018 - Expert discusses how to identify, support individuals with drug or alcohol addiction in workplace
January 16, 2018 - Starting menstruation early increases risk of cardiovascular disease and stroke in later life
January 16, 2018 - CapsoVision receives CE Mark approval for use of CapsoCam Plus System in pediatric patients
January 16, 2018 - Researchers develop new dynamic statistical model to follow gene expressions over time
January 16, 2018 - Alzheimer’s ‘looks like me, it looks like you’
January 16, 2018 - By the Numbers: Physicians’ Economic Impact
January 16, 2018 - Sound Health | NIH News in Health
January 16, 2018 - Modifying baby formula doesn’t prevent type 1 diabetes in children
January 16, 2018 - Energy drinks dangerous for kids
January 16, 2018 - When you need a breast screening, should you get a 3-D mammogram?
January 16, 2018 - Johns Hopkins gets approval to perform HIV positive to HIV positive living donor kidney transplants
January 16, 2018 - The Salk Institute and Indivumed collaborate for cutting-edge cancer research
January 16, 2018 - Study reveals negative long-term effects of heavy cannabis use on brain function and behavior
January 16, 2018 - Many gym-goers injure themselves by pushing harder to be better than friends
January 16, 2018 - Risankizumab Meets All Primary Endpoints Reporting Positive Results in Fourth Pivotal Phase 3 Psoriasis Study
January 16, 2018 - Federal Junk Food Tax Feasible, Study Says
January 16, 2018 - Do girls have stronger teeth than boys?
January 16, 2018 - New high-sensitivity blood tests could aid faster diagnosis and treatment for heart attack
January 16, 2018 - How fatal mitochondrial diseases may strike offspring of families with no history of the conditions
January 16, 2018 - TherapeuticsMD Announces FDA Acceptance of New Drug Application and Prescription Drug User Fee Act (PDUFA) Date for TX-004HR
January 16, 2018 - Morning Break: Food Pharmacies; Obamacare Sign-ups Dip; Top Pot Studies
January 16, 2018 - Blood pressure declines 14 to 18 years before death
January 16, 2018 - ViLim Ball technology helps reduce uncontrollable shaking hands
TCT: Hybrid Revascularization Safe Mid-Term But Not Better … Yet

TCT: Hybrid Revascularization Safe Mid-Term But Not Better … Yet

image_pdfDownload PDFimage_print

DENVER — A hybrid surgery plus stenting procedure for multivessel coronary artery disease didn’t improve outcomes or cut residual ischemia compared with a purely surgical approach or stenting alone, a small head-to-head trial showed.

Residual ischemia at 12 months was found by single-photon emission CT (SPECT) in 6.4% of patients with left internal mammary artery grafting (LIMA) of the left anterior descending (LAD) coronary artery and drug-eluting stents for other blocked vessels compared with 6.7% of patients with coronary artery bypass grafting alone (CABG) alone and 7.9% of patients with drug-eluting stents (DESs) alone.

The 12-month freedom from major adverse cardiac and cerebral events events was 88.6% compared with 88.0% , and 86.8%, respectively among the arms, none of which differed significantly in the HREV trial.

Target vessel or graft failure was likewise similar across arms, at 11.5%, 12.0%, and 11.3%, respectively, Roman Tarasov, MD, PhD, of the State Research Institute for Complex Issues of Cardiovascular Diseases in Kemerovo, Russia, reported at a press conference here at the Transcatheter Cardiovascular Therapeutics meeting.

Press conference moderator Roxana Mehran, MD, of the Icahn School of Medicine at Mount Sinai in New York City, noted that the importance of this small study — really the first pilot study that has hybrid multivessel, PCI and CABG head-to-head — is in finding the hybrid approach is safe.

“Hybrid revascularization is something we talked about 2 decades ago. Because we knew — before drug-eluting stents came along — we knew the best therapy to LAD to protect the patient is LIMA … We know that vein grafts also don’t have the durability as a LIMA to the LAD. So the best of two worlds would be a LIMA to the LAD, and drug-eluting stents do extremely well in the non-LAD distribution, hence hybrid revascularization.”

While logistically challenging, she said, “I do believe there are a tremendous number of sites in the U.S. that have some appetite for this. Especially now with heart team approach now … we are having shared decisions with [patients] and the heart team to give them best of both worlds. But you have to prove this is the best possible treatment modality for these patients, which means long follow-up and good comparator arms.”

The Cardiothoracic Surgical Network’s Hybrid Coronary Revascularization Trial funded by the NIH should give the more definitive answer, said David Cohen, MD, of Saint Luke’s Mid-America Heart Center in America Heart Institute in Kansas City, Missouri, a press conference discussant.

“Really, the benefit of the LIMA is not the first year so much, it’s 10 years, 20 years. And I think it’s going to take something on that order to really show the benefit of this type of approach,” he said.

The trial included 150 patients randomized to the three treatment arms at a single Russian center. Left main and chronic total occlusion were excluded, as were other scenarios for which the three procedures weren’t deemed equally feasible.

Hybrid procedures were minimally-invasive, off-pump revascularization of the left anterior descending artery with the left internal mammary artery followed by consecutive percutaneous coronary intervention (PCI) in the rest of the arteries, done in two stages within 3 days. All PCI was done with the same second-generation Xience V and Xience Prime DES.

Nearly 10% of the hybrid group (five patients) required conversion to conventional on-pump CABG with a median sternotomy for surgical technical reasons (two cases) or due to hemodynamic instability following grafting in the absence of other lesion revascularization (three cases). However, there was less with BARC 3-4 bleeding than with CABG (9.6% versus 20.0%).

The trial was sponsored by the Russian Academy of Medical Sciences.

The researchers disclosed no relevant relationships with industry.

2017-10-31T12:23:36-0400

Tagged with:

About author

Related Articles