Coronary artery bypass grafting versus percutaneous coronary intervention in single-vessel left anterior descending...

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
• Percutaneous coronary intervention (PCI) with drug-eluting stents (SES) is increasingly used, even for extensive disease, with varied results.
• Comparing CABG with skeletonized internal mammary artery (IMA) graft versus SES-PCI for single-vessel left anterior descending (LAD) artery disease is crucial.

Purpose of the Study:

• To compare the immediate- and mid-term outcomes of CABG-IMA versus SES-PCI in patients with single-vessel LAD disease.
• To evaluate differences in mortality, hospital stay, and major adverse cardiovascular and cerebrovascular events (MACCE).

Main Methods:

• A study included 938 patients treated for isolated LAD revascularization between 2014-2022.
• Propensity score-matching compared 266 patients undergoing CABG-IMA with 266 patients receiving SES-PCI.
• Primary outcomes included 30-day and 3-year all-cause mortality; secondary outcomes were hospital stay and MACCE incidence.

Main Results:

• PCI-SES showed a higher incidence of post-procedural MACCE (5.3%) compared to CABG-IMA (1.2%; p < 0.05).
• No significant differences in 30-day or 3-year mortality were observed between the groups.
• Patients undergoing SES-PCI had a significantly shorter hospital stay (3.8 days) than those treated with CABG-IMA (7.7 days; p < 0.05).

Conclusions:

• CABG-IMA demonstrates superior performance compared to SES-PCI for myocardial revascularization in single-vessel LAD disease.
• The study's conclusions are independent of traditional risk scores like Logistic EuroSCORE II and SYNTAX Score II.
• The observed differences are attributed to the procedural methods rather than patient-specific risk factors.