OBJECTIVES: Minimally invasive direct coronary artery bypass (MIDCAB) has been proposed to reduce surgical morbidity and improve long-term outcomes compared with stenting in the treatment of isolated proximal left anterior descending artery. However, the survival benefit from MIDCAB still needs to be demonstrated, in particular, because percutaneous coronary intervention with drug-eluting stents (DES-PCI) continues to be considered the initial treatment strategy. We conducted a 10-year follow-up, single-center, propensity score-matched MIDCAB versus DES-PCI comparison. METHODS: A total of 1033 patients (303 MIDCAB and 730 DES-PCI) with isolated proximal left anterior descending disease were included. Propensity score matching was used to compare 303 pairs of MIDCAB and DES-PCI patients. RESULTS: MIDCAB and DES-PCI presented with comparable 30-day mortality (2 of 303 [0.6%] vs 1 of 303 [0.3%]; P=1.0). At 10 years, DES-PCI was associated with a 2.19-fold increased risk of late death (95% confidence interval, 1.15-4.17), a 2.0-fold increased risk of repeat revascularization (95% confidence interval, 1.20-3.47), and a 2.14-fold increased risk of the composite of death and repeat revascularization (95% confidence interval, 1.41-3.24). CONCLUSIONS: These findings strongly support a survival benefit from MIDCAB at long-term follow-up compared with DES-PCI in the treatment of isolated left anterior descending disease.
OBJECTIVES: Minimally invasive direct coronary artery bypass (MIDCAB) has been proposed to reduce surgical morbidity and improve long-term outcomes compared with stenting in the treatment of isolated proximal left anterior descending artery. However, the survival benefit from MIDCAB still needs to be demonstrated, in particular, because percutaneous coronary intervention with drug-eluting stents (DES-PCI) continues to be considered the initial treatment strategy. We conducted a 10-year follow-up, single-center, propensity score-matched MIDCAB versus DES-PCI comparison. METHODS: A total of 1033 patients (303 MIDCAB and 730 DES-PCI) with isolated proximal left anterior descending disease were included. Propensity score matching was used to compare 303 pairs of MIDCAB and DES-PCI patients. RESULTS: MIDCAB and DES-PCI presented with comparable 30-day mortality (2 of 303 [0.6%] vs 1 of 303 [0.3%]; P=1.0). At 10 years, DES-PCI was associated with a 2.19-fold increased risk of late death (95% confidence interval, 1.15-4.17), a 2.0-fold increased risk of repeat revascularization (95% confidence interval, 1.20-3.47), and a 2.14-fold increased risk of the composite of death and repeat revascularization (95% confidence interval, 1.41-3.24). CONCLUSIONS: These findings strongly support a survival benefit from MIDCAB at long-term follow-up compared with DES-PCI in the treatment of isolated left anterior descending disease.
Authors: Monica Gianoli; Anne R de Jong; Kirolos A Jacob; Hanae F Namba; Niels P van der Kaaij; Pim van der Harst; Willem J L Suyker Journal: Int J Cardiol Heart Vasc Date: 2022-05-10
Authors: Rafik Abusamra; Marek Król; Krzysztof Milewski; Mateusz Kachel; Loai Abudaqa; Justyna Jankowska-Sanetra; Kamil Derbisz; Krzysztof Sanetra; Anna Sobieszek; Piotr P Buszman; Wojciech Wojakowski; Paweł E Buszman; Andrzej Bochenek; Marek Cisowski Journal: Cardiol J Date: 2019-01-31 Impact factor: 2.737