Minimally invasive direct coronary artery bypass graft surgery versus percutaneous coronary intervention of the LAD: costs and long-term outcome

Abstract

Objective: Outcomes and treatment costs for coronary artery disease involving the left anterior descending coronary artery (LAD) are influenced by the type of treatment, which can be either isolated minimally invasive revascularization of the LAD using the internal thoracic artery (ITA) (MIDCAB) or percutaneous coronary intervention (PCI) on the LAD. This retrospective study sought to evaluate long-term survival, freedom from re-intervention and cost analysis after MIDCAB compared to PCI on the LAD. Methods: Between 2006 and 2012, from a total of 561 patients, 106 consecutive patients with LAD stenosis underwent a MIDCAB procedure whereas 100 patients underwent elective PCI. Urgent and emergent cases were excluded from the present study (n = 355). Detailed analysis of the outcome data was performed for both groups. A Kaplan–Meier survival estimation with up to 10-year follow-up was applied for both groups for survival analysis and freedom from re-intervention. Results: There were no statistically significant differences in terms of clinically relevant baseline characteristics. The outcome in the MIDCAB group was superior regarding long-term overall survival, accounting for 100% versus 92.8% at 1 year, 98.5% versus 82.1% at 6 years and 79.6% versus 61.5% at 10 years (Log Rank (Mantel-Cox) p = 0.011) and freedom from re-intervention at 10 years (97.2% vs. 86.7%, Log Rank (Mantel-Cox) p = 0.001). Intensive care unit (ICU) stay (p = 0.020) and total hospital stay (p<0.001) were significantly longer in the MIDCAB group, which was also associated with higher in-hospital costs (10,879 € vs. 4009 €, p<0.001). Conclusions: Whereas patients undergoing MIDCAB remained longer on ICU and in hospital, causing higher costs, this procedure was associated with a significantly lower incidence of repeat revascularization and significantly lower mortality compared to PCI on the LAD.

Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis

“…On the basis of the inclusion and exclusion criteria, further eliminations were carried out: 293 articles were eliminated because they were based on a follow-up time period less than 10 years; 62 publications were meta-analyses, systematic reviews, or literature reviews; 21 articles were case studies; and 130 articles were duplicated studies. Finally, only eight studies [16][17][18][19][20][21][22][23] including three randomized trials and five observational cohorts were selected for this analysis as shown in Fig. 1.…”

“…The mean age of the participants varied from 41.9 to 67.0 years. The study by Merkle [20] consisted of the eldest participants in the PCI group with a mean age of 67.0 years, whereas the study by Thuijs [23] consisted of the eldest participants who underwent CABG with a mean age of 65.0 years. In contrast, the study by Li [19] involved the youngest participants with a mean age of 41.9 years for those who were categorized in the PCI group and 42.0 years for those who were categorized within the CABG group.…”

“…In addition, the percentages of participants with comorbidities such as hypertension (23.0-86.8%), dyslipidemia (33.6-81.5%), and current smoker (4.00-66.0%) have also been listed. As shown in Table 3, the study by Merkle [20] consisted of the highest percentage of patients with hypertension, whereas the study by Park [21] consisted of the lowest number of participants with hypertension. In addition, dyslipidemia was highest in the study by Thuijs [23], whereas cigarette smoking was lowest in this same study.…”

A Nationwide Study of Clinical Outcomes After Robot-Assisted Coronary Artery Bypass Surgery and Hybrid Revascularization in the Netherlands

“…We found a myocardial infarction rate of 1.4%, which is similar to prior reports. 15 , 16 Patients presenting with myocardial infarction were treated aggressively: 4 patients underwent PCI with stenting of the LAD, 1 patient underwent a PCI with stenting of the LITA-LAD conduit, and 1 patient underwent a reoperation for revision of the LITA-LAD conduit.…”

Review of Contemporary Techniques for Minimally Invasive Coronary Revascularization

“… 31 Finally, Merkle et al reported higher costs associated with the MIDCAB group versus the PCI group in their analysis (10,879€ vs 4,009€). 32 …”