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

References

Authors

Dong Seop Jeong, Young Tak Lee, Su Ryeun Chung, Jae Han Jeong, Wook Sung Kim, Kiick Sung and Pyo Won Park

Reference

Eur J Cardiothorac Surg (2013) 44 (3): 718-724

Published

October 2013

Link

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My Comment

Background

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.

Major findings

  • 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

My comments

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.

1 comment

  • funck francois 18 Oct 2013

    off pump surgery did not show any improvement versus on pump surgery, except for high risk old people ; the différence between DES PCI and surgery depend also on location of the stenosis ( proximal / medium or distal ) and if it's associated with multiple lesions or not . and last point : sample volume of this study is not so large ; so interesting study but results have to be seen with détails and caution