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Midterm follow-up after minimally invasive direct coronary artery bypass grafting versus percutaneous coronary
Sandra Fraund1, Gunhild Herrmann, Anja Witzke
1Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany. sfraund@kielheart.uni-kiel.de
Insights
Minimally invasive direct coronary artery bypass grafting (MIDCAB) shows superior midterm results compared to percutaneous coronary intervention (PCI) for left anterior descending artery revascularization, primarily due to a lower need for repeat procedures.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Revascularization of the left anterior descending coronary artery is crucial for managing coronary artery disease.
- Minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI) are primary treatment options.
- Comparative analysis of midterm outcomes for MIDCAB versus PCI is essential for clinical decision-making.
Purpose of the Study:
- To compare the midterm clinical outcomes of MIDCAB and PCI for left anterior descending coronary artery revascularization.
- To evaluate differences in periprocedural complications, need for revascularization, and major adverse cardiac events.
Main Methods:
- Retrospective analysis of 206 MIDCAB and 256 PCI patients treated between 1998 and 2001.
- Patient allocation determined by cardiologists based on clinical judgment.
- Midterm follow-up up to 5.2 years, including quality-of-life assessment using the SF-36 questionnaire.
Main Results:
- No significant differences in periprocedural or overall mortality between MIDCAB and PCI groups.
- PCI group required significantly more repeated revascularization of the left anterior descending artery (24.2% vs. 0% in MIDCAB, p < 0.001).
- Major adverse cardiac events were higher in the PCI group, mainly driven by the need for repeated revascularization.
Conclusions:
- MIDCAB demonstrates superior midterm results compared to PCI, specifically in reducing the need for repeat revascularization.
- No significant differences were observed in other major cardiac events or quality of life between the two methods.
- The findings support MIDCAB as a favorable option for specific patients requiring left anterior descending artery revascularization.
Background:
Revascularization of the left anterior descending coronary artery can be performed by minimally invasive direct coronary artery bypass grafting (MIDCAB) or percutaneous coronary intervention techniques (PCI). The study compared the midterm results of both techniques.
Methods:
The outcome of 206 consecutive MIDCAB and 256 PCI patients treated from 1998 until 2001 was retrospectively analyzed. Cardiologists determined the primary patient allocation for the distinct revascularization technique. Periprocedural complications and midterm follow-up, including quality-of-life assessment (SF-36), was reported up to 5.2 years (3.4 +/- 0.7 years).
Results:
Periprocedural and overall mortality (p = 0.206) showed no differences. Four MIDCAB patients required early reoperation but not for repeated target vessel revascularization. In 16 patients secondary PCI (7.8%) of other coronary vessels was performed. Repeated revascularization of the left anterior descending coronary artery was necessary in 24.2% of patients in the PCI group (p < 0.001), with 4.7% finally requiring surgical revascularization. The incidence of major adverse cardiac events, including myocardial infarction (p = 0.581), repeated target vessel revascularization (p < 0.001), or death (p = 0.206) was higher in the PCI group. This difference consisted basically of the need for repeated target vessel revascularization. Patient-based quality-of-life assessment (SF-36) was independent from the primary chosen revascularization method.
Conclusions:
At midterm follow up, MIDCAB resulted in significantly superior results regarding the need for repeated target vessel revascularization compared with PCI, with no significant differences regarding other major cardiac events.
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