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Percutaneous Coronary Intervention Versus Robotic Coronary Bypass for Left Anterior Descending Artery Chronic Total
Elsa Hebbo1, Wissam A Jaber1, Giancarlo Licitra1
1Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Insights
Robotic-assisted coronary artery bypass (CAB) surgery demonstrated superior long-term survival free of major adverse cardiovascular events (MACE) compared to percutaneous coronary interventions (PCI) for left anterior descending chronic total occlusion (LAD CTO). This benefit is partly due to fewer comorbidities in CAB patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Technology
Background:
- Left anterior descending (LAD) chronic total occlusion (CTO) revascularization can be achieved via percutaneous coronary intervention (PCI) or robotic-assisted coronary artery bypass (CAB).
- Comparing long-term clinical outcomes of these two revascularization strategies is crucial for patient management.
Purpose of the Study:
- To compare the long-term clinical outcomes of robotic-assisted CAB versus PCI for LAD CTO.
- To evaluate survival rates, myocardial infarction, and repeat revascularization between the two groups.
Main Methods:
- Retrospective analysis of 273 patients with LAD CTO undergoing either PCI (n=129) or CAB (n=144).
- Kaplan-Meier curves and log-rank tests were used for survival analyses, including freedom from MACE, myocardial infarction, and repeat revascularization.
- Long-term follow-up data were available for 96 PCI and 125 CAB patients.
Main Results:
- Patients undergoing PCI had a higher prevalence of comorbidities, including diabetes, lower ejection fraction, and prior heart failure.
- Robotic-assisted CAB patients showed significantly higher rates of survival free of MACE compared to PCI patients (unadjusted HR, 2.39).
- PCI patients experienced higher rates of myocardial infarction and repeat revascularization, though the latter was attenuated after adjusting for comorbidities.
Conclusions:
- Robotic-assisted CAB offers superior 5-year survival free of MACE compared to PCI for LAD CTO.
- The higher comorbidity burden in PCI patients partially explains the observed outcome differences.
- Both strategies are viable, but patient selection considering comorbidities is important.
Background:
Both percutaneous coronary interventions (PCIs) and robotic-assisted coronary artery bypass (CAB) offer viable options for left anterior descending (LAD) chronic total occlusion (CTO) revascularization. Our study aims to compare long-term clinical outcomes associated with these 2 strategies.
Methods:
In this retrospective study, we analyzed data from 273 patients diagnosed with LAD CTO who underwent either PCI (n = 129) or CAB (n = 144) at a single institution. Long-term follow-up was available for 96 PCI and 125 CAB patients. We employed Kaplan-Meier curves and the log-rank test to conduct cumulative survival analyses free of major adverse cardiovascular events (MACE), cumulative survival, survival free of myocardial infarction, and repeat revascularization.
Results:
In the study cohort, patients who underwent PCI exhibited a higher prevalence of comorbidities including diabetes (48.9% vs 24.6%; P < .001), lower ejection fraction (44 ± 14 vs 52 ± 10; P < .001), prior heart failure (36.6% vs 22.2%; P = .02), and prior bypass surgery (16% vs 0, P < .001). PCI to non-LAD vessels was performed as part of initial complete revascularization in 40.3% of PCI and 40.6% of CAB patients. Upon a median 3.4 years of follow-up, CAB patients had significantly higher rates of survival free of MACE compared to PCI patients (unadjusted hazard ratio, 2.39; 95% CI, 1.13-5.03). Although PCI patients had similar unadjusted mortality, they experienced higher myocardial infarction and repeat revascularizations compared to CAB. However, the risk of repeat revascularization was attenuated after adjusting for prior bypass, diabetes, and ejection fraction.
Conclusions:
Among patients with LAD CTO, those undergoing robotic-assisted CAB had a higher 5-year overall survival free of MACE compared to those who underwent PCI. This discrepancy in outcomes can be attributed in part to the greater burden of comorbidities among PCI patients.
