Revascularization for Isolated Proximal Left Anterior Descending Artery Disease
Edward L Hannan1, Ye Zhong1, Kimberly Cozzens1
1School of Public Health, University at Albany, State University of New York, Albany, New York.
Insights
For isolated proximal left anterior descending (PLAD) coronary artery disease, conventional coronary artery bypass graft (CABG) surgery showed lower revascularization rates than percutaneous coronary intervention (PCI). No significant differences in mortality or major adverse events were observed among the three procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Isolated proximal left anterior descending (PLAD) coronary artery disease studies often exclude at least one revascularization option.
- Percutaneous coronary intervention (PCI), conventional coronary artery bypass graft (CABG) surgery, and minimally invasive CABG are key treatment modalities.
Purpose of the Study:
- To compare the long-term outcomes of PCI, conventional CABG, and minimally invasive CABG for isolated PLAD disease.
- To evaluate differences in mortality, myocardial infarction, stroke, and revascularization rates across the three procedures.
Main Methods:
- Utilized New York cardiac registries to identify 14,327 patients with isolated PLAD disease treated between 2010-2016.
- Matched registry data with vital statistics and claims data for comprehensive outcome tracking through 2017.
- Employed adjusted analyses to account for patient risk factor differences.
Main Results:
- No significant differences in 7-year mortality or the composite of mortality/myocardial infarction/stroke were found among PCI, conventional CABG, and minimally invasive CABG.
- Conventional CABG surgery demonstrated significantly lower rates of subsequent revascularization compared to PCI (aHR 0.45) and minimally invasive CABG (aHR 0.46).
Conclusions:
- Conventional CABG surgery is associated with reduced need for repeat revascularization in patients with isolated PLAD disease.
- All three revascularization strategies (PCI, conventional CABG, minimally invasive CABG) offer comparable long-term survival and freedom from major adverse cardiovascular events.
Background:
Most studies of patients with isolated proximal left anterior descending (PLAD) coronary artery disease do not include all 3 procedural options: percutaneous coronary intervention (PCI), conventional coronary artery bypass graft (CABG) surgery, or minimally invasive CABG.
Methods:
New York's cardiac registries were used to identify patients who underwent revascularization for isolated PLAD disease between January 1, 2010, and November 30, 2016, in New York State. After exclusions, 14,327 patients, of whom 13,115 received PCI, 1001 of whom underwent CABG surgery, and 211 of whom underwent minimally invasive CABG were monitored through the end of 2017 to compare outcomes. Registry data were matched to vital statistics data to obtain deaths occurring after discharge and matched to claims data to obtain subsequent admissions for myocardial infarction and stroke.
Results:
There were no significant differences in mortality or in mortality/myocardial infarction/stroke after 7 years (with median follow-up times in excess of 4 years) among the 3 procedures after adjusting for differences in patient risk factors. However, conventional CABG surgery was associated with a lower subsequent revascularization rate than PCI (adjusted hazard ratio, 0.45; 95% confidence interval, 0.35-0.58) and minimally invasive CABG surgery (adjusted hazard ratio, 0.46; 95% confidence interval, 0.32-0.66).
Conclusions:
Among patients with isolated PLAD disease undergoing any of 3 revascularization options (PCI, conventional CABG surgery, or minimally invasive CABG surgery), conventional CABG surgery was associated with lower subsequent revascularization rates, but there were no differences in mortality or mortality/myocardial infarction/stroke rates.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:24Cardiac Catheterization III: Left Heart Catheterization
01:27Peripheral Artery Disease III: Interprofessional Care