Long-term outcomes of minimally invasive direct coronary artery bypass vs second generation drug eluting stent for management of isolated left anterior descending artery disease.

Introduction: This study aimed to compare the long-term outcomes in a propensity matched population receiving either minimally invasive direct coronary artery bypass (MIDCAB) using left internal thoracic artery (LITA) to the left anterior descending artery (LAD) or percutaneous coronary intervention using second generation everolismus-eluting stents (DES-PCI) in patients treated for isolated proximal LAD stenosis.

Methods: Between January 2012 and December 2017, 421 patients with a nonemergency status undergoing primary isolated proximal LAD revascularization were retrospectively analyzed and were divided into two groups: 111 patients receiving MIDCAB LITA to LAD and 310 patients receiving DES-PCI. Propensity score matching selected 111 pairs and both groups were comparable for all baseline characteristics and well balanced.

Results: In the matched cohort, median follow-up time was 5.19 years (interquartile range, 3.50-6.96). MIDCAB and DES-PCI had comparable long-term outcomes in terms of mortality (Hazard ratio (HR) stratified on matched pairs: 1.60; 95 %CI; 0.58-4.37; P = 0.36), stroke (HR stratified on matched pairs: 0.44; 95 %CI; 0.04-5.13; P = 0.51) and major adverse cardiac and cerebral events (MACCE) (HR stratified on matched pairs:0.57; 95 %CI; 0.26-1.22; P = 0.14). However, MIDCAB was associated with reduced incidence of myocardial infarction (MI) (HR stratified on matched pairs:0.46; 95 %CI; 0.15-0.0.56; P = 0.001) as well as reduced incidence of target vessel repeat revascularization (TVR) (HR stratified on matched pairs: 0.12; 95 %CI; 0.0.01-0.92; P = 0.015).

Conclusion: MIDCAB LITA-LAD offers superior freedom from MI rate and TVR with similar mortality, stroke and MACCE compared with second generation DES-PCI in the treatment of isolated proximal LAD disease.