Revascularization of Left Anterior Descending Artery with Minimaly Invasive Direct Coronary Artery Bypass Graft Vs Drug eluting stents- Long term outcomes.

Background: Left Anterior Descending Artery (LAD) Revascularization is a prominent step while treating patients with severe coronary artery disease. LAD revascularization can be achieved by Percutaneous Coronary Interventions (PCI) or by coronary artery bypass grafting (CABG) procedures. Minimally invasive direct CABG (MIDCAB) is a surgical strategy that enables surgical revascularization of the LAD without midsternotomy or utilization of extracorporal circulation.

Objective: We sought to compare the long term clinical outcomes of LAD revascularization with Drug Eluting Stents (DES) versus MIDCAB surgery.

Method: Between May 2002 to December 2003, 272 patients who underwent PCI to the LAD with DES (Cypher) were retrospectively compared with 104 patients who underwent MIDCAB surgery deploying the left IMA to the LAD in two major health-centers in Israel.

Results: After Matching for Age, sex, and extent of coronary disease, two groups of 83 matched patients were created. Mean follow up was 16 years. The groups were similar except for EF<35% that was more prevalent in the MIDCAB group and Prior PCI’s that were more prevalent in the DES Group.

thirty-day mortality was 1.1% in the MIDCAB group and 0% for the DES group (p=0.11).

10-year survival was 81%±4.3% for the DES group and 77.1%±4.6% for the MIDCAB group.

20-year survival was 56.1%±5.5% for the DES group and 60.2%±5.4% for the MIDCAB group (p=0.734). In multivariate analysis we found age, congestive heart failure, chronic renal failure and more than 3 vessel PCI to be associated with increased mortality.

Conclusion: Long term outcomes were comparable for both treatment strategies and correlated well to the general mortality within the age relevant healthy population. However, considering the limited matching policy, the inability to evaluate late major adverse cardiac events and the actual cause of death precluded a more accurate evaluation of the precise benefits and drawbacks of each revascularization strategy.