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Long‐term clinical outcomes of coronary artery bypass graft surgery compared to those of percutaneous coronary intervention with second generation drug eluting stents in patients with stable angina and an isolated lesion in the proximal left anterior descending artery
Author(s) -
Matsoukis Ioannis L.,
Karanasos Antonios,
Patsa Chrysoula,
AnousakisVlachochristou Nikolaos,
Triantafyllou Konstantinos,
Kantzanou Maria,
Drakopoulou Maria,
Tsiamis Eleftherios,
Latsios George,
Synetos Andreas,
Petridou Eleni Th,
Tousoulis Dimitris,
Toutouzas Konstantinos
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29247
Subject(s) - medicine , percutaneous coronary intervention , conventional pci , cardiology , hazard ratio , myocardial infarction , revascularization , angina , coronary artery disease , unstable angina , drug eluting stent , artery , surgery , confidence interval
Objectives We compared the long‐term outcomes of percutaneous coronary intervention with second‐generation drug‐eluting stents (PCI‐DES) and coronary artery bypass graft surgery (CABG) with the left internal mammary artery in stable angina patients with isolated single‐vessel proximal left anterior descending artery (pLAD) disease. Background Long‐term outcomes of second‐generation PCI‐DES and CABG in isolated pLAD lesions have not been extensively studied. Methods We included 631 PCI‐DES patients and 379 CABG patients. Unadjusted and adjusted hazard ratios (HRs) were derived for major adverse cardiac events (MACEs), their components (cardiac death, nonfatal myocardial infarction [MI] not attributed to a non‐target vessel, target‐lesion revascularization), and patient‐related outcome (PRO, composed of all‐cause mortality, any MI, any revascularization). Results In the unadjusted and adjusted analyses, no significant difference was observed between the two groups at follow‐up (mean:4.6 ± 2.5 years) for MACEs (HR: 1.45, 95% CI: 0.92–2.28, p = .11; HR:1.43, 95% CI: 0.91–2.26, p = .13), PRO (HR: 1.18, 95%CI: 0.86–1.61, p = .30; HR: 1.18, 95% CI: 0.86–1.62, p = .31), cardiac death (HR: 0.97, 95% CI: 0.46–2.05, p = .93; HR: 0.79, 95% CI: 0.36–1.72, p = .56) and MI (HR: 1.43, 95% CI: 0.49–4.13, p = .51; HR: 1.57, 95% CI: 0.53–4.64, p = .42). Compared with CABG, PCI‐DES had a borderline significantly greater risk of repeat revascularization (HR: 1.99, 95% CI: 1.00–3.94, p = .05; HR: 1.95, 95% CI: 0.98–3.9, p = .06). Angina recurred more often after PCI ( p < .001), whereas more arrhythmias developed after CABG ( p = .02). PCI‐DES resulted in fewer in‐hospital complications (p < .001) and shorter hospitalizations ( p < .001). Conclusions The long‐term clinical outcomes of second‐generation PCI‐DES and CABG in patients with stable angina and isolated pLAD disease were comparable.