Revascularization of Left Anterior Descending Artery with Minimally Invasive Direct Coronary Artery Bypass Graft vs. Drug Eluting Stents: A Retrospective, Two-Center Study

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Abstract
Background/Objectives: Revascularization of the left anterior descending (LAD) artery can be achieved by either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Minimally invasive direct CABG (MIDCAB) enables LAD revascularization via a small thoracotomy without sternotomy or cardiopulmonary bypass. To compare long-term survival following LAD revascularization by MIDCAB or following PCI using drug-eluting stents (DES), of the historic cohort we reported in 2006. Methods: Data were assessed of 272 patients who underwent LAD PCI with DES, and 104 patients who underwent MIDCAB using the left internal thoracic artery (LITA) to LAD, in two major centers, between May 2002 and December 2003. Matching for age, sex, and extent of coronary disease yielded two balanced groups of 83 patients each. Results: Baseline characteristics were similar with a mean age ± standardized difference (SD) of 64.70 ± 12.52 of the MIDCAB group vs. 63.59 ± 12.06 of the Cypher group and an identical male to female ratio of 66 to 83 (79.5%), except for a higher prevalence of EF < 35% in the MIDCAB group and prior PCI in the DES group. Thirty-day mortality was 1.1% after MIDCAB and 0% after DES-PCI (p = 0.11). At 2 years, the proportion of recurrent angina was lower after MIDCAB (8.4% vs. 35%; p < 0.001), as was the proportion of re-interventions (3.6% vs. 16.8%; p = 0.005). Over a mean follow-up of 16 years, 10-year survival was 77.1 ± 4.6% for the MIDCAB and 81.0 ± 4.3% for the DES group (p = 0.48). The rates of 20-year survival were 60.2 ± 5.4% and 56.1 ± 5.5%, respectively (p = 0.73). In multivariable analysis, advanced age and prior myocardial infarction independently predicted mortality while treatment with MIDCAB showed a trend toward improved survival (p = 0.053). Conclusions: Long-term survival rates after LAD revascularization with MIDCAB and after DES-PCI were comparable. MIDCAB demonstrated a non-significant trend toward lower mortality. Limitations include the retrospective design and lack of detailed late event adjudication.

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