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Background In spite of continuing progress in percutaneous coronary intervention (PCI), recanalization of CTO still remains a challenge for invasive cardiologists. Yet recent advances in PCI materials, devices, approaches, and techniques have allowed expert operators to successfully tackle complex cases of CTO that many years ago have been sent patients to coronary artery bypass surgery (CABG). A comparison between revascularization of isolated left anterior descending (LAD) artery CTO through PCI and that by coronary artery bypass grafting may not be previously studied. Aim of the work To evaluate short and intermediate term outcome of revascularization of LAD CTO in symptomatic patients by PCI and to compare this outcome with LAD CTO revascularization through CABG. Patients and methods: A prospective single center observational study. The present study was performed on 80 patients with LAD CTO identified at coronary angiography of Sohag Cathlab of Internal Medicine Department, Sohag University Hospital during the period from January 2012 to March 2013. All patients had a native vessel total occlusion of LAD of at least three months duration based on a history of sudden chest pain, a previous MI in the same target vessel territory, or the time between diagnosis made on coronary angiography and PCI. All patients had symptomatic angina and/or a positive functional study for ischemic heart disease (Thallium 201 radionuclide perfusion imaging). Patients were divided into 2 groups according to coronary angiography in which Group 1: include 40 patients underwent successful PCI. Group 2: include 40 patients underwent CABG. Results: During the period of follow up ( 12 months) , total MACE ( major adverse cardiac events) was more common in PCI group (10 patients, 25%) than in CABG group (6 patients, 15%, P= 0.049) but there was no significant difference in death (2[5%] in PCI vs 2 [5%] in CABG), MI (2 [5%] in PCI vs (1[2.5%] in CABG) or stroke (1[2.5%] in PCI vs 1 [2.5%] in CABG) between both groups but repeat revascularization was not significantly higher in PCI group (5 patients, 12.5%) than CABG group (2 patient, 5%, P=0.083). Summary and Conclusion: Our findings suggest that CABG remained a superior intervention for patients with isolated LAD CTO lesion than PCI. The most benefit of CABG was to reduce the odds of repeat revascularization as compared with PCI in a short-term follow-up.

arc journal of cardiology

Revascularization of Left Anterior Descending Coronary Artery Chronic Total Occlusion by Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting(Early and Mid Term Outcome)