Long-term outcomes of percutaneous coronary intervention and minimally invasive direct coronary artery bypass (MIDCAB) in complex LAD lesion
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
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Mardanyan G.V., Abugov S.A., Zhbanov I.V., Puretskiy M.V., Polyakov R.S.,
Saakyan Yu.M., Pirkova A.A., Vartanyan E.L., Kraynikov D.A., Lev G.V. Long-term
outcomes of percutaneous coronary intervention and minimally invasive direct
coronary artery bypass (MIDCAB) in complex LAD lesion. Clinical and
Experimental Surgery. Petrovsky Journal. 2021; 9 (3): 74-81. DOI: https://doi.org/10.33029/2308-1198-2021-9-3-74-81 (in Russian)
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