Revascularization in left main coronary artery disease: comparison of off-pump coronary artery bypass grafting vs percutaneous coronary intervention
Selected in European Journal of Cardio-Thoracic Surgery by Rylski
Dong Seop Jeong, Young Tak Lee, Su Ryeun Chung, Jae Han Jeong, Wook Sung Kim, Kiick Sung and Pyo Won Park
Eur J Cardiothorac Surg (2013) 44 (3): 718-724
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Drug-eluting stents (DES) along with advances in interventional techniques have significantly improved the outcomes of patients undergoing percutaneous coronary intervention (PCI). In the same time, recent reports demonstrated improved outcome of patients undergoing off-pump coronary artery bypass (OPCAB) with use of arterial grafting. The authors aimed to compare the clinical outcomes of patients with unprotected left main coronary artery (LMCA) disease who had undergone PCI or OPCAB.
- OPCAB was performed in 553 and PCI in 346 patients with LMCA disease
- 159 propensity-matched pair were identified
- The early mortality was lower in OPCAB patients (0 vs 5%, P < 0.001), however the overall survival at 8 years was similar in both groups
- Freedom from major adverse cardiac and cerebrovascular events (MACCE) at 8 years was higher OPCAB group (84% vs 60%, P < 0.001)
- PCI patients had higher risk of acute myocardial infarction and higher rates of target-vessel revascularization at follow-up
- The incidence of stroke was similar in both groups
The authors addressed an important aspect of myocardial revascularisation. They presented, that OPCAB applying predominantly total arterial revascularisation is superior to PCI using DUS in patients with unprotected LMCA disease. The beneficial OPCAB results were determined mainly by the lower incidences of acute myocardial infarction and target vessel revascularization. This study confirmed the importance of current guidelines of both American and European Societies recommending coronary artery bypass surgery in LMCA treatment.