Comparison of the Outcomes of Single vs Multiple Arterial Grafts in Women

Description

The 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.

Conditions

Heart Diseases, Coronary Artery Disease, Coronary Artery Bypass Grafting

Study Overview

Study Details

Study overview

The 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.

Randomized Comparison of the Outcomes of Single vs Multiple Arterial Grafts in Women (ROMA:Women) Trial

Comparison of the Outcomes of Single vs Multiple Arterial Grafts in Women

Condition
Heart Diseases
Intervention / Treatment

-

Contacts and Locations

Los Angeles

Cedars-Sinai Medical Center, Los Angeles, California, United States, 90048

Aurora

University of Colorado, Aurora, Colorado, United States, 80045

New Haven

Yale University Hospital, New Haven, Connecticut, United States, 06510

Atlanta

Emory University, Atlanta, Georgia, United States, 30322

Chicago

University of Chicago, Chicago, Illinois, United States, 60637

Baltimore

Johns Hopkins University, Baltimore, Maryland, United States, 21218

Springfield

Baystate Health, Springfield, Massachusetts, United States, 01199

Worcester

University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States, 01655

Saint Louis

Washington University in St. Louis, Saint Louis, Missouri, United States, 63110

Lincoln

Nebraska Heart Hospital, Lincoln, Nebraska, United States, 68526

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility 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.
  • * 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

Ages Eligible for Study

18 Years to

Sexes Eligible for Study

FEMALE

Accepts Healthy Volunteers

No

Collaborators and Investigators

Weill Medical College of Cornell University,

Mario Gaudino, Prof/PhD/MD, PRINCIPAL_INVESTIGATOR, Weill Medical College of Cornell University

Stephen Fremes, MD, PRINCIPAL_INVESTIGATOR, Sunnybrook Health Sciences Centre

Ruth Masterson Creber, RN, PhD, PRINCIPAL_INVESTIGATOR, Columbia University

C. Noel Bairey Merz, MD, PRINCIPAL_INVESTIGATOR, Cedars-Sinai

Karla Ballman, PhD, PRINCIPAL_INVESTIGATOR, Weill Medical College of Cornell University

Sean O'Brien, PhD, PRINCIPAL_INVESTIGATOR, Duke University

Study Record Dates

2030-03