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DES yielded higher MACCE than MIDCAB in LAD revascularization
Drug-eluting stent implantation was associated with similar survival but poorer major adverse events than minimally invasive coronary artery bypass surgery in a cohort of patients requiring revascularization of the left anterior descending artery, according to recent results.
Researchers conducted the prospective study of 456 patients undergoing isolated left anterior descending (LAD) revascularization to compare minimally invasive coronary artery bypass surgery (MIDCAB) with first-generation DES in this patient population. According to the researchers, MIDCAB offers the advantage of preserving the benefit of internal mammary artery use compared with conventional sternotomy.
For the study, eligible patients received the procedures between 1997 and 2011. There were 260 patients in the MIDCAB group and 196 who received a DES. The investigators created a propensity score model to adjust for 19 confounding variables they deemed relevant.
Five-year survival served as the primary endpoint. Freedom from MACCE served as the secondary outcome measure.
There were few differences between the groups in terms of age, EuroSCORE or mean duration of follow-up, according to the results.
MIDCAB and DES yielded similar 5-year survival outcomes (HR=0.95; P=.89). However, MIDCAB was associated with significant improvements in MACCE (HR=0.32; P<.0001). The difference was a result of a high requirement of subsequent revascularization of the targeted vessel of the DES (HR=0.17; P<.0001).
“While late patency of internal mammary anastomoses remains perfectly stable, late results of first-generation DES have been disappointing; occurrence of complications related to unexpected stent thrombosis, late recurrence of restenosis or anticoagulation management has led to virtual withdrawal of these stents,” the researchers concluded. “Further studies with long-term follow-up will be mandatory to ensure clinical efficacy of next-generation devices.”
Disclosure: The researchers report no relevant financial disclosures.