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Background  The study compared downstream coronary and conduit disease progression in the left anterior descending coronary artery treated with coronary artery bypass grafting using the left internal mammary artery ( LIMA ) versus percutaneous coronary intervention with bare metal stent ( BMS ) or drug eluting stent ( DES ).    Methods and Results  A total of 12 301 consecutive patients underwent isolated primary coronary revascularization, of which 2386 met our inclusion criteria (Percutaneous coronary intervention, n=1450; coronary artery bypass grafting, n=936). Propensity score analysis matched 628 patients, of which 468 were treated to the left anterior descending with coronary artery bypass grafting with  LIMA  (n=314), percutaneous coronary intervention with  BMS  (n=94), and  DES  (n=60). Coronary angiograms were analyzed by quantitative coronary angiography ( QCA ; n=433). Cumulative downstream coronary and conduit disease progression were estimated by Kaplan–Meier method and effect of treatment type by Cox proportional hazard models. Patients treated with  LIMA  had significantly lower risk of downstream coronary disease progression at follow‐up angiogram compared with  BMS  and  DES  (hazard ratio [ HR ] [95%  CI ], 0.34; [0.20–0.59];  P =0.0002; and  HR  [95%  CI ], 0.39; [0.20–0.79];  P =0.01, respectively).  LIMA  was associated with a lower risk of conduit disease progression compared to  BMS  and  DES  ( HR  [95%  CI ], 0.18; [0.12–0.28];  P <0.001; and  HR  [95%  CI ], 0.27; [0.16–0.46];  P <0.001, respectively).  BMS  was associated with higher  HR  for downstream coronary and conduit disease progression compared with  DES , but the difference did not reach statistical significance ( HR  [95% CI], 1.13; [0.57–2.36];  P =0.73; and  HR  [95%  CI ], 1.46; [0.88–2.50];  P =0.14, respectively).    Conclusions   LIMA  grafting to left anterior descending is associated with significantly lower risk of downstream coronary and conduit disease progression compared to percutaneous coronary intervention with  BMS  and  DES .

Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency