Comparison of the Outcomes of Single vs Multiple Arterial Grafts in Women
Coronary Artery Disease | Heart Diseases | Coronary Artery Bypass GraftingThe central hypothesis of ROMA:Women is that the use of multiple arterial grafting (MAG) will improve clinical outcomes and quality of life (QOL) compared to single arterial grfating (SAG).
The specific aims of ROMA:Women are:
Aim 1: Determine the impact of MAG vs SAG on major adverse cardiac and cerebrovascular events in women undergoing coronary artery bypass grfating (CABG). The investigators will compare major adverse cardiac and cerebrovascular events (death, stroke, non-procedural myocardial infarction, repeat revascularization, and hospital readmission for acute coronary syndrome or heart failure) in a cohort of 2,000 women randomized 1:1 to MAG or SAG (690 from the parent ROMA trial + 1,310 from ROMA:Women). Differences by important clinical and surgical subgroups (patients younger or older than 70 years, diabetics, racial and ethnic minorities, on vs off pump CABG, type of arterial grafts used) will also be evaluated. The women enrolled in the ongoing ROMA trial (anticipated to be approximately 690) will be included in ROMA:Women, increasing efficiency and reducing enrollment time.
Hypothesis 1.0. MAG will reduce the incidence of major adverse cardiac and cerebrovascular events.
Hypothesis 1.1. The improvement with MAG will be consistent across key subgroups.
Aim 2: Determine the impact of MAG vs SAG on generic and disease-specific QOL, physical and mental health symptoms in women undergoing CABG. The investigators will compare generic (SF-12, EQ-5D) and disease-specific (Seattle Angina Questionnaire) QOL and physical and mental health symptoms (PROMIS-29) in a sub-cohort of 500 women randomized 1:1 to MAG or SAG (including those enrolled in ROMA:QOL). Differences by important subgroups (as defined above) will also be evaluated.
Hypothesis 2.0. MAG will improve generic and disease-specific QOL compared to SAG.
Hypothesis 2.1. MAG will improve physical and mental health symptoms compared to SAG.
Hypothesis 2.2. The improvement with MAG will be consistent across key subgroups.
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Participation Requirements
-
Sex:
FEMALE -
Eligible Ages:
18 and up
Participation Criteria
Inclusion Criteria:
1. Women patients ≥18 years old.
2. Isolated coronary artery bypass grafting.
3. Primary (first time) cardiac surgery procedure.
4. Significant disease of the left main coronary artery or of the left anterior descending and the circumflex coronary system with or without disease of the right coronary artery.
Exclusion Criteria:
* Male gender
* Single graft
* Emergency operation
* Myocardial infarction within 72 hours of surgery
* Left ventricular ejection fraction \< 35%
* Any concomitant cardiac or non-cardiac procedure
* Previous cardiac surgery
* Preoperative severe end-organ dysfunction (dialysis, liver failure, respiratory failure), cancer or any co-morbidity that reduces life expectancy to less than 5 years.
* Inability to use the saphenous vein or to use both radial and right internal thoracic arteries
* Anticipated need for coronary thrombo-endarterectomy
* Planned hybrid revascularization
Study Location
Hamilton General Hospital
Hamilton General HospitalHamilton, Ontario
Canada
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Andre Lamy, MD
Sunnybrook Health Sciences
Sunnybrook Health SciencesToronto, Ontario
Canada
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Stephen E Fremes, MD
Royal Victoria Hospital
Royal Victoria HospitalMontréal, Quebec
Canada
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Kevin Lachapelle, MD
NL Health Services
NL Health ServicesSt. John's, Newfoundland and Labrador
Canada
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Janet Ngu, MD
Health Sciences North
Health Sciences NorthSudbury, Ontario
Canada
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Bindu Bittira, MD
University Hospital of Montreal
University Hospital of MontrealMontréal, Quebec
Canada
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Nicolas Noiseux, MD
St. Boniface General Hospital
St. Boniface General HospitalWinnipeg, Manitoba
Canada
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Rakesh Arora, MD
London Health Sciences
London Health SciencesLondon, Ontario
Canada
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David Nagpal, MD
Toronto General Hospital
Toronto General HospitalToronto, Ontario
Canada
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Vivek Rao, MD
Institut Universitaire de Cardiologie et de Pneumologie de Québec
Institut Universitaire de Cardiologie et de Pneumologie de QuébecSte Foy, Quebec
Canada
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Pierre Voisine, MD
Horizon Health Network - Saint John Regional Hospital
Horizon Health Network - Saint John Regional HospitalSaint John, New Brunswick
Canada
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Craig Brown, MD
University of Ottawa Heart Institute
University of Ottawa Heart InstituteOttawa, Ontario
Canada
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Marc Ruel, MD
Montreal Heart Institute
Montreal Heart InstituteMontréal, Quebec
Canada
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Philippe Demers, MD
- Study Sponsored By
- Weill Medical College of Cornell University
- Participants Required
- More Information
- Study ID:
NCT04124120