Study Compares CABG Versus DESs to Treat Isolated Proximal Left Anterior Descending Disease

December 30, 2014—In the Journal of the American College of Cardiology (JACC), Edward L. Hannan, PhD, et al, published findings from a study that sought to compare outcomes in patients with proximal left anterior descending (PLAD) coronary artery disease who underwent coronary artery bypass graft (CABG) surgery and percutaneous coronary interventions (PCI) with drug-eluting stents (DESs) (2014;64:2717–2726). The investigators noted that few recent studies have compared the outcomes of CABG surgery with PCI in patients with isolated (single vessel) PLAD coronary artery disease in the era of DESs.

As summarized in JACC, the investigators used New York’s Percutaneous Coronary Interventions Reporting System to identify and track all patients who underwent CABG surgery and received DES for isolated PLAD disease between January 1, 2008, and December 31, 2010, and who were followed-up through December 31, 2011.

Of 6,064 patients, 5,340 (88%) received DESs. Patients were matched to vital statistics data to obtain mortality after discharge and matched to New York’s administrative data to obtain readmissions for myocardial infarction (MI) and stroke. To minimize selection bias, patients were propensity matched into 715 CABG and/or DES pairs, and three outcome measures were compared across the pairs.

The investigators found that Kaplan-Meier estimates for CABG and DES did not significantly differ for mortality or mortality, MI, and/or stroke, but repeat revascularization rates were lower for CABG (7.09% vs 12.98%; P = .0007). After further adjustment with Cox proportional hazards models, there were still no significant differences in 3-year mortality rates (CABG and/or DES adjusted hazard ratio [AHR]: 1.14; 95% confidence interval [CI], 0.7 to 1.85) or mortality, MI, and/or stroke rates (AHR: 1.15; 95% CI, 0.76 to 1.73), and the repeat revascularization rate remained significantly lower for CABG patients (AHR: 0.54; 95% CI, 0.36 to 0.81).

The investigators concluded that despite the higher rating in current guidelines of CABG (class IIa vs class IIb) for patients with isolated PLAD disease, there were no differences in mortality or mortality, MI, and/or stroke, although CABG patients had significantly lower repeat revascularization rates, concluded the investigators in JACC.