Abstract 2331: Comparison of Minimally Invasive Coronary Bypass Surgery with Implantation of Drug-eluting Stents in Patients with Left Anterior Descending Coronary Artery Disease
Background: Bypass surgery and percutaneous coronary interventions (PCI) improve the clinical status of patients with left anterior descending (LAD) coronary artery disease, however these techniques differ in invasiveness and in the need for subsequent reinterventions. The development of minimally invasive coronary artery bypass surgery (MIDCAB) and of drug eluting stents (DES) offer perspectives to close this gap.
Methods: We compared the long-term (up to 5-year) clinical outcome of 236 patients after revascularization for symptomatic, isolated LAD coronary artery disease. 129 patients were treated with MIDCAB and 107 with PCI and DES implantation.
Results: Both groups were similar in age (64±3 and 64±0 years), Euroscore (3.4±.8 and 3.7±.6) at the time of intervention and duration of follow-up 17±7 and 4±0 months). Survival was similar after MIDCAB and after DES (93.8% and 91.6%) and two patients (1.6%) suffered a cerebrovascular accident in the MIDCAB group. During follow-up, for the target vessel 4 patients (3%) in the MIDCAB group and 11 (10%) in the DES group needed subsequent revascularization (p<.05). However, for the none target vessel 21pts (16%) in the MIDCAB group and 17 patients (16%) in the DES group also needed reintervention ( NS ). Total major adverse coronary and cerebrovascular events (MACCE) rates were similar in the MIDCAB (25%) and in the DES (31%) groups. Similar proportions of patients were free of anginal complaints in the MIDCAB (81%) and in the DES (79%) groups.
Conclusion: MIDCAB and DES implantation showed similar rates of mortality and myocardial revascularization during follow-up. The majority of subsequent revascularization procedures are related to disease progression on remote vessels, masking the clinical impact of a higher reintervention rate on the target site after DES.