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PCI, MIDCAB offer similar 10-year outcomes, different TVR rate
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PCI and minimally invasive direct coronary artery bypass surgery in isolated proximal left anterior descending lesions yielded similar long-term outcomes for death, MI or target vessel revascularization at 10 years, although the rate of TVR was higher with PCI, according to study results.
To assess the 10-year long-term safety and effectiveness of the two procedures for proximal left anterior descending lesions, researchers randomly assigned 220 patients to PCI or minimally invasive direct coronary artery bypass surgery (MIDCAB).
They reported no significant difference in the incidence death, MI or TVR between PCI and MIDCAB (RR=0.81; 95% CI, 0.62-1.05). A time-to-event analysis revealed a difference in event rates favoring MIDCAB (HR=0.65; 95% CI, 0.43-0.98), which was mainly driven by a higher event rate in the PCI group in the first 7 months (HR=0.31; 95% CI, 0.17-0.57) compared with 7 months to 10 years (HR=1.29; 95% CI, 0.71-2.3).
Patients receiving PCI required TVR more often than MIDCAB patients at 10 years (34% vs. 11%; P<.01), which, according to a time-to-event analysis, was largely caused by a higher TVR rate from 0 to 7 months (HR=0.25; 95% CI, 0.13-0.47) compared with 7 months to 10 years (HR=0.71; 95% CI, 0.22-2.23).
“An important reason for the higher TVR rate in the PCI group might have been the use of [bare-metal stents] and the mandatory follow-up angiography at 6 months. Routine angiographic follow-up leads to additional revascularizations in comparison with sole clinical follow-up,” researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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