Objectives: Revascularization by Coronary Artery Bypass surgery or by Percutaneous Coronary Interventions (PCI) improve the clinical status of patients with left anterior descending (LAD) coronary artery disease. However, recent evolutions of the two techniques (the development of minimally invasive coronary artery bypass surgery (MIDCAB) and of drug eluting stents (DES)) could modify our strategy in this field.
Methods: We retrospectively compared the clinical outcome of 350 patients after revascularization for isolated LAD coronary artery disease. 175 consecutive patients were treated with MIDCAB and 175 consecutive patients with PCI and DES implantation.
Results: Both groups were similar in age (63±13 and 63±10 years), Euroscore (3.4±2.8 and 3.5±2.6) and mean duration of follow-up (32±17 and 28±10 months). 2-year survival was similar after MIDCAB and after DES (96.9% and 93,9%) but 6 patients (3.4%) of the MIDCAB group while 26 patients (15.2%) of the DES group needed subsequent revascularization of the LAD (p=0,001), including 2 patients with acute stent thrombosis in the DES group. Neurological complications included 2 transient ischemic accidents and 2 strokes in the MIDCAD group but 3 fatal cerebral hemorrhages and 1 stroke in the DES group. Major adverse cardiac and cerebrovascular events (MACCE) rates were 14% in the MIDCAB and 34% in the DES group at 2 years. No differences were found between diabetic and non diabetic patients.
Conclusions: MIDCAB and DES implantation showed similar rates of mortality but a higher reintervention rate after DES. Management of anticoagulation will remain critical for the future of DES.
Drug-eluting Stents versus Minimally Invasive Coronary Bypass Surgery for revascularization of the Left Anterior Descending Coronary ArteryPierre Yves Etienne, David Glineur, Spiridon Papadatos, Yves Mairy, Christophe Laruelle, Gebrine El Khoury, Philippe Noirhomme, Claude Hanet
Clinique St Luc, Namur - Cliniques Universitaires St Luc, Brussels |