Long-term outcomes of percutaneous coronary intervention and minimally invasive direct coronary artery bypass (MIDCAB) in complex LAD lesion

• Gayk V. Mardanyan
• Abugov S.A.
• Zhbanov I.V.
• Puretskiy M.V.
• Polyakov R.S.
• Saakyan Yu.M.
• Pirkova A.A.
• Vartanyan E.L.
• Kraynikov D.A.
• Gela V. Lev

Abstract

The optimal method of myocardial revascularization for isolated complex lesions of the left anterior descending artery, taking into account the current state of endovascular technologies and the development of minimally invasive direct coronary bypass grafting, remains a subject of discussion. The aim - the selection of the optimal method of myocardial revascularization in the basin of the left anterior descending artery, depending on the type of lesion. Tasks: to evaluate and compare the clinical efficacy and safety of PCI and MIDCAB in patients with complex non-occlusive LAD lesion; to evaluate and compare the clinical efficacy and safety of PCI and MIDCAB in patients with chronic total occlusion of LAD.

Material and methods. 207 patients with coronary artery disease and complex LAD lesions participated in the study. They underwent PCI or MIDCAB from 2010 to 2019 at the Petrovsky National Research Centre of Surgery. The average follow-up period was 58±25 months. Longterm effectiveness and safety of revascularization methods were examined. The study endpoint is a combined indicator - major adverse cardio and cerebrovascular events (MACCE - the composite of death, myocardial infarction, repeated revascularization, stroke).

Results. There were no significant differences both in the study endpoint (combination of death, myocardial infarction, stroke, repeat revascularization) and in individual components. MACCE were observed in 13.2% of patients in the PCI group and in 8.9% of patients in the MIDCAB group: RR=1.47, 95% CI 0.64-3.3, p=0.5. The effectiveness of the methods, expressed in the number of repeated revascularizations, did not differ significantly 6.2 versus 2.5%: RR=2.4, 95% CI 0.6-9.9, p=0.32 for PCI and MIDCAB respectively. Safety (a combination of deaths, myocardial infarction and stroke) in the PCI and MIDCAB groups also did not differ - 7 versus 6.4%, p=1.0. When analyzing subgroups of patients with chronic LAD occlusion, the number of repeated interventions in the MIDCAB group was smaller, however, the difference was statistically insignificant according to the 58±25 months of observation period - 9.8 versus 2.1%: RR=4.61, 95% CI 0,56-38, p=0.2. 

Conclusion. In patients with coronary artery disease and complex LAD lesions, PCI using the latest generations of drug-eluting stents and the MIDCAB operation provide comparable high clinical efficacy and safety in the long-term (58±25 months) period, regardless of the type of lesion.

Keywords:ischemic heart disease, myocardial revascularization, LAD complex lesion, PCI, CABG, MIDCAB (Minimally Invasive Direct Coronary Artery Bypass), drug-eluting stents

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