Midcab Vs Pci With DES For Isolated Lesion Of The Lad
Hiroshi Seki, Dai Une, Mimiko Tabata, Atsushi Kurata.
Yamato Seiwa Hospital, Yamato, Japan.
BACKGROUND: Both minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention with drug-eluting stent (DES-PCI) are established therapeutic options for coronary artery disease.
However, it is still unknown which is the more optimal procedure regarding the long-term for revascularization of isolated disease of left ascending artery (LAD).
The scope if this study was to assess and compare the clinical outcomes of MIDCAB and DES-PCI in single LAD lesion in the real world setting.
METHODS: This is a retrospective, observational single center study.
Data of patients who underwent MIDCAB or PCI with DES at our institute between Sep 2006 and Feb 2010 were collected retrospectively. Among them, patients with single LAD disease (proximal or mid-portion of LAD) were identified. Patients with left main trunk, right coronary artery and left circumflex artery lesions were excluded.
28 patients were included in the MIDCAB group, and 72 patients in the PCI group. Mean age was 66.1 in the MIDCAB group, and 70.8 in the PCI group. Only LAD and its branches were grafted in all included cases. Left internal thoracic artery was used as the graft in all MIDCAB cases. Average follow up period was 6.1 years in MIDCAB group and 7.8 years in PCI group. Freedom from all cause death was 96.0% and 94.2% after 7 years and freedom from repeat revascularization of the target vessel was 91.3% and 61.8% after 8 years in the MIDACB and PCI group respectively, which was significantly higher in the MIDCAB group (p=0.02). MIDCAB was related to relatively decreased risk of the composite endpoint including death myocardial infarction, and repeat revascularization, though it didn't reach statistical significance.
The incidence of peri-procedural major bleeding and cerebrovascular disease were very rare, and did not differ between the revascularization techniques.
CONCLUSIONS: MIDCAB and Stenting with DES for isolated LAD lesions was associated with similar outcomes with low risk of major adverse outcomes in the long-term. MIDCAB showed a lower incidence of repeat revascularization. Selection of treatment is important to ensure optimal results for patients with isolated LAD disease regarding the characteristics of the procedure.
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