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

References

Authors

Etienne PY, D'hoore W, Papadatos S, Mairy Y, El Khoury G, Noirhomme P, Hanet C, Glineur D.

Reference

Eur J Cardiothorac Surg (2013) 44 (5): 884-890

Published

November 2013

Link

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My Comment

Background

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.

Major findings

  • 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

My comments

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.

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