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Outcomes after CABG, DES similar for patients with isolated proximal left anterior descending CAD
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Patients with isolated proximal left anterior descending CAD who underwent CABG or received drug-eluting stents had similar 3-year rates of mortality, MI and stroke, but a significantly lower rate of repeat revascularization after CABG surgery.
The current study focused on all patients who underwent CABG surgery and received DES for isolated proximal left anterior descending CAD in the New York Percutaneous Coronary Interventions Reporting System from 2008 to 2010. Of 6,064 patients included in the analysis, 5,340 received DES and 724 underwent CABG surgery. Patients who received DES were more likely to be female, nonwhite or nonblack, have a higher BMI and ejection fraction, and were less likely to have a history of MI, cerebrovascular disease, peripheral vascular disease, congestive HF, chronic obstructive pulmonary disease or malignant ventricular arrhythmia.
In unadjusted analyses, patients who received DES had significantly lower rates of mortality (4.3% vs. 5.9%; P=.04) and mortality/MI/stroke (6.1% vs. 8.3%; P=.03), but higher repeat revascularization rates (12.2% vs. 6.5%; P<.0001) compared with patients who underwent CABG surgery. Most of the repeat revascularizations were PCIs.
The researchers also used propensity score matching to minimize selection bias in this observational study, yielding 715 propensity-matched CABG pairs and 715 propensity-matched DES pairs.
Propensity score matching also demonstrated no significant differences in 3-year mortality (CABG and/or DES adjusted HR=1.14; 95% CI, 0.7-1.85) or mortality/MI/stroke (adjusted HR=1.15; 95% CI, 0.76-1.73). Again, rates of repeat revascularization were significantly lower for patients who underwent CABG surgery (adjusted HR=0.54; 95% CI, 0.36-0.81).
Analyses restricted to patients with diabetes and with no history of MI before CABG or DES demonstrated similar results, with repeat revascularization rates favoring CABG.
“Most patients with isolated proximal left anterior descending disease undergo PCI. Despite the fact that current guidelines have a stronger rating for CABG (IIa vs. IIb) for these patients, there were no differences between CABG and DES in mortality or mortality, MI and/or stroke, although it is important to note that CABG patients had significantly lower repeat revascularization rates,” the researchers concluded.
Disclosure: The researchers report associations with companies including Abbott Vascular, Angioscore, Boston Scientific, Capricor, Cardiovascular Systems, Celanova, DSI/Lilly, Eli Lilly, Medtronic, Merck, The Medicine Company and Wyeth.
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