UMC Utrecht plays a key role in an international clinical trial investigating a potentially less invasive treatment for patients with multiple narrowed coronary arteries. Led in the Netherlands by Prof. Dr Michiel Voskuil, cardiologist at UMC Utrecht, physicians in the HYCORE-1 trial are studying whether a hybrid treatment that combines minimally invasive bypass surgery with percutaneous coronary intervention can lead to improved outcomes and faster recovery.
In 30–50% of patients with coronary artery disease, multiple coronary arteries are affected. The international HYCORE-1 trial investigates the optimal treatment strategy for this group of patients. The standard treatment for patients with multivessel disease is open coronary artery bypass grafting (CABG). Although effective, this procedure is invasive: the chest must be opened and recovery can take several months. In addition, a proportion of venous bypass grafts, typically veins taken from the leg, fail within a few years.
Arterial bypass grafts generally demonstrate better long-term outcomes. In these procedures, surgeons typically use an artery from the chest wall, known as the left internal mammary artery (LIMA). The HYCORE-1 trial investigates whether patients with multivessel coronary artery disease can be treated using a less invasive strategy while achieving at least comparable, or potentially better, outcomes.
In the study, a hybrid coronary revascularization strategy is applied. One artery (LIMA) from the chest wall is used as a bypass graft via a minimally invasive direct coronary artery bypass (MIDCAB) procedure. This technique does not require a heart-lung machine and the breastbone does not need to be opened. The procedure is combined with percutaneous coronary intervention (PCI) to treat the remaining narrowed arteries. Researchers will compare this combined approach with the current standard CABG procedure.
The societal impact of this research could be substantial. If the hybrid approach proves effective, it could lead to faster recovery, fewer complications and hospital readmissions, and a lower burden on healthcare systems. For patients, it may also result in an improved quality of life.
A total of 1,200 patients from several European countries will participate in the international trial. Approximately 700 patients will be enrolled through six participating centers in the Netherlands. The Dutch participation in the HYCORE-1 trial is led by Prof. Dr Michiel Voskuil, interventional cardiologist at UMC Utrecht, who coordinates the study within the Netherlands. In this study, he works closely with cardiothoracic surgeon Dr Monica Gianoli from UMC Utrecht. If all goes according to plan, the researchers hope to include the first patients around 1 June. The first results are cautiously expected around 2030–2031. The primary endpoints of the study include mortality, myocardial infarction, stroke and hospital admissions within one year, supplemented by patient-reported symptoms and quality-of-life measures.
The research is supported by funding from the Dutch Heart Foundation (Hartstichting, in Dutch).
