Five-year follow-up of drug-eluting stents implantation vs minimally invasive direct coronary artery bypass for left anterior descending artery disease: a propensity score analysis
Selected in European Journal of Cardio-Thoracic Surgery by Rylski
Etienne PY, D'hoore W, Papadatos S, Mairy Y, El Khoury G, Noirhomme P, Hanet C, Glineur D.
Eur J Cardiothorac Surg (2013) 44 (5): 884-890
LinkAccess the article
Latest contributionsOutcome after coronary artery bypass grafting and percutaneous coronary intervention in patients with stage 3b-5 chronic kidney disease MitraClip therapy and surgical edge-to-edge repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation: mid-ter... Suprasternal direct aortic approach transcatheter aortic valve replacement avoids sternotomy and thoracotomy: first-in-man experience
Both drug-eluting stents (DES) and minimally invasive coronary artery bypass surgery (MIDCAB) have significantly improved during the past few years. The incidence of early restenosis following percutaneous coronary interventions (PCI) has been reduced and MIDCAB offers currently minimally invasive revascularisation using the internal mammary artery. The authors aimed to compare the long-term clinical outcomes of patients with left main coronary artery (LMCA) disease who had undergone PCI or MIDCAB applying a propensity score matched analysis.
- 456 patients underwent isolated LMCA revascularisation (260 MIDCAB and 196 first-generation DES)
- 5-year survival was similar after MIDCAB or PCI (HR 0.95, P = 0.89)
- Freedom from major adverse cerebrocardiovascular events (MACCE) was significantly in favour of the MIDCAB patients (HR 0.32, P < 0.0001) mainly due to high need for secondary revascularisation of the targeted vessel in the DES group
The comparison of surgical and interventional revascularisation techniques gains currently increasing attention. This investigation on first generation DES shows that in patients with isolated LMCA disease, revascularisation with either DES or MIDCAB is associated with a similarly low mortality rate after 5 years, however, reinterventions remain significantly higher and continuous over time after PCI. Results of the first generations of DES are disappointing and the patency of internal mammary anastomoses remains perfectly stable.