Comparison of Sirolimus-Eluting Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

Abstract

At 7-year follow-up, PCI by SES and MIDCAB in isolated proximal left anterior descending lesions yielded similar long-term outcomes regarding the primary composite clinical endpoint and quality of life. Target vessel revascularization was more frequent in the PCI group. (MIDCAB Versus DES in Proximal LAD Lesions; NCT00299429).

Evaluation of the Incidence of Major Adverse Cardiac and Cerebrovascular Events after Percutaneous Coronary Intervention or Coronary Artery Bypass Graft on Proximal Left Anterior Descending Artery with and without Other Coronary Arteries Involvement

“…Nonetheless, the rate of TVR was higher in the PCI group (13). A meta-analysis of 12 studies including more than 2000 patients revealed comparable survival rates after MIDCAB and PCI with DES on proximal LAD stenosis, with significantly higher need for revascularization in the PCI group due to angina recurrence (14).…”

Coronary Artery Bypass Surgery Is Not Underutilized!

“…Seven-year follow-up in this study was recently reported and found no significant difference in the composite of death, MI, and repeat revascularization between PCI and CABG (22% versus 12%, P=0.17). 20 The numeric difference was attributable to a significantly higher repeat revascularization rate in the PCI arm (20% versus 1.5%, P<0.001). The rate of death (14% versus 17%, P=0.81) and MI (6% versus 9%, P=0.74) was not different between PCI and CABG, respectively, at 7-year follow-up (Table).…”

“…17 These comparisons are hampered by the use of bare metal stents and the early experience with minimally invasive CABG, but because there are no significant differences in major end points out to 10 years, it is difficult to argue that CABG is underutilized in this setting, although certainly the associated need for more repeat procedures in the patients initially treated with PCI means that clinical decision making should include discussions with the patients about the trade-offs of an initially less morbid procedure (PCI) but more repeat procedures. 18 In a more recent study by Blazek and colleagues, 19 130 patients with isolated proximal lAD disease were randomly assigned to PCI with the first-generation sirolimus-eluting stent or to minimally invasive CABG. PCI was found to be noninferior in comparison with CABG at 1 year with a major adverse cardiac event rate of 7.7% in both arms (P=0.03 for noninferiority).…”

The future of off-pump coronary artery bypass grafting: a North American perspective

“…Blazek et al (32) showed equivalent 7-year survival in 130 patients with single vessel LAD disease randomized to MIDCAB vs. DES-PCI. There was no difference in the composite primary endpoint of all-cause mortality, MI and repeat revascularization but as expected, there was a significantly higher incidence of repeat revascularization with PCI (HR, 13.50; 95% CI: 1.76-103.29; P<0.001).…”