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MIDCAB, SES yield similar outcomes in proximal LAD lesions
New 7-year data demonstrate similar long-term safety and effectiveness after PCI with sirolimus-eluting stents or minimally invasive direct coronary artery bypass surgery in patients with isolated proximal left anterior descending, or LAD, lesions.
The study reported outcomes at 7 years for 65 patients randomly assigned to PCI with sirolimus-eluting stents (SES) and 65 patients randomly assigned to minimally invasive direct coronary artery bypass surgery (MIDCAB).
The median follow-up duration in 129 patients was 7.3 years (interquartile range, 5.7-8.3). One patient assigned SES was lost to follow-up, according to the researchers.
The incidence of the primary composite endpoint of death, MI and target vessel revascularization was similar with SES (22%) and MIDCAB (12%; P = .17; RR = 1.47; 95% CI, 0.82-2.62).
When the researchers examined components of the primary outcome separately, patients assigned SES and MIDCAB had similar rates of all-cause death (14% vs. 17%, respectively; P = .81), cardiac death (3% vs. 1.5%; P = .62) and MI (6% vs. 9%, respectively; P = .74), but a higher rate of TVR with SES (20% vs. 1.5%; P < .001) after 7 years of follow-up.
Landmark analyses at 12 months and 12 months to 7 years also showed no significant differences between SES and MIDCAB for these outcomes.
In other results, the researchers observed no acute, subacute or late stent thromboses through 7 years among patients assigned SES.
Both SES and MIDCAB yielded significant improvements from baseline in clinical symptoms and quality of life. Among patients assigned SES, the Canadian Cardiovascular Society (CCS) classification score at 7 years was 0. Seventy-five percent of patients were free from angina at late follow-up. Among patients assigned MIDCAB, the CCS score was also 0, and 86% of patients were free from angina at late follow-up. SF-36 and MacNew quality of life questionnaire scores were not significantly different between patients assigned SES or MIDCAB.
Disclosure: The researchers report no relevant financial disclosures.