TY - JOUR
T1 - Revascularization for Isolated Proximal Left Anterior Descending Artery Disease
AU - Hannan, Edward L.
AU - Zhong, Ye
AU - Cozzens, Kimberly
AU - Adams, David H.
AU - Girardi, Leonard
AU - Chikwe, Joanna
AU - Wechsler, Andrew
AU - Sundt, Thoralf M.
AU - Smith, Craig R.
AU - Gold, Jeffrey P.
AU - Lahey, Stephen J.
AU - Jordan, Desmond
N1 - Funding Information:
The authors wish to acknowledge that The Icahn School of Medicine at Mount Sinai receives royalty agreements for intellectual property related to the development of valve repair products from Edward Lifesciences and Medtronic. Dr Adams is the National Co-Primary Investigator of the Medtronic APOLLO FDA Pivotal Trial, the NeoChord ReChord FDA Pivotal Trial, The Medtronic CoreValve US Pivotal Trial, and the Abbott TRILUMINATE Pivotal Trial.
Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/8
Y1 - 2021/8
N2 - Background: Most studies of patients with isolated proximal left anterior descending (PLAD) coronary artery disease do not include all 3 procedural options: percutaneous coronary intervention (PCI), conventional coronary artery bypass graft (CABG) surgery, or minimally invasive CABG. Methods: New York's cardiac registries were used to identify patients who underwent revascularization for isolated PLAD disease between January 1, 2010, and November 30, 2016, in New York State. After exclusions, 14,327 patients, of whom 13,115 received PCI, 1001 of whom underwent CABG surgery, and 211 of whom underwent minimally invasive CABG were monitored through the end of 2017 to compare outcomes. Registry data were matched to vital statistics data to obtain deaths occurring after discharge and matched to claims data to obtain subsequent admissions for myocardial infarction and stroke. Results: There were no significant differences in mortality or in mortality/myocardial infarction/stroke after 7 years (with median follow-up times in excess of 4 years) among the 3 procedures after adjusting for differences in patient risk factors. However, conventional CABG surgery was associated with a lower subsequent revascularization rate than PCI (adjusted hazard ratio, 0.45; 95% confidence interval, 0.35-0.58) and minimally invasive CABG surgery (adjusted hazard ratio, 0.46; 95% confidence interval, 0.32-0.66). Conclusions: Among patients with isolated PLAD disease undergoing any of 3 revascularization options (PCI, conventional CABG surgery, or minimally invasive CABG surgery), conventional CABG surgery was associated with lower subsequent revascularization rates, but there were no differences in mortality or mortality/myocardial infarction/stroke rates.
AB - Background: Most studies of patients with isolated proximal left anterior descending (PLAD) coronary artery disease do not include all 3 procedural options: percutaneous coronary intervention (PCI), conventional coronary artery bypass graft (CABG) surgery, or minimally invasive CABG. Methods: New York's cardiac registries were used to identify patients who underwent revascularization for isolated PLAD disease between January 1, 2010, and November 30, 2016, in New York State. After exclusions, 14,327 patients, of whom 13,115 received PCI, 1001 of whom underwent CABG surgery, and 211 of whom underwent minimally invasive CABG were monitored through the end of 2017 to compare outcomes. Registry data were matched to vital statistics data to obtain deaths occurring after discharge and matched to claims data to obtain subsequent admissions for myocardial infarction and stroke. Results: There were no significant differences in mortality or in mortality/myocardial infarction/stroke after 7 years (with median follow-up times in excess of 4 years) among the 3 procedures after adjusting for differences in patient risk factors. However, conventional CABG surgery was associated with a lower subsequent revascularization rate than PCI (adjusted hazard ratio, 0.45; 95% confidence interval, 0.35-0.58) and minimally invasive CABG surgery (adjusted hazard ratio, 0.46; 95% confidence interval, 0.32-0.66). Conclusions: Among patients with isolated PLAD disease undergoing any of 3 revascularization options (PCI, conventional CABG surgery, or minimally invasive CABG surgery), conventional CABG surgery was associated with lower subsequent revascularization rates, but there were no differences in mortality or mortality/myocardial infarction/stroke rates.
UR - http://www.scopus.com/inward/record.url?scp=85110573056&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85110573056&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2020.08.049
DO - 10.1016/j.athoracsur.2020.08.049
M3 - Article
C2 - 33144114
AN - SCOPUS:85110573056
SN - 0003-4975
VL - 112
SP - 555
EP - 562
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -