Long Term Outcomes of Pci and Cabg for Isolated Proximal Lad Lesions: A Real World Comparison

Purpose: The clinical prognosis for untreated, high-grade proximal LAD lesions is poor. Previous studies investigating revascularisation strategies in this patient cohort have almost exclusively compared PCI using BMS with CABG in stable patients. We therefore compared clinical outcomes in patient's whom underwent revascularisation for isolated proximal LAD lesions in our institution. Methods: We undertook an observational cohort study of unselected, consecutive patients who underwent single vessel proximal LAD revascularization at a large university hospital from April 2000-August 2011. The clinical database was linked to the administrative Discharge Abstract Database of the Canadian Institute for Health Information and the Registered Persons Database. Due to significant differences in baseline variables between the groups propensity matching of the PCI to CABG cohorts was undertaken at a 2:1 ratio. Results: 1753 patients were included. 1596 had PCI and 157 patients underwent CABG. The mean follow up period was 5.5 years and 7 years respectively. The unadjusted mortality in the PCI group was 11.5% (n=183) and 7% (n=11) in the CABG group. Of the PCI patients 37.8% had DES implanted. The propensity matched PCI (n = 294) and CABG (n=147) cohorts were well balanced with respect to all baseline characteristics including age, diabetes, renal impairment, procedural urgency, presentation and LV impairment. There was no difference in mortality between the PCI group and CABG group: 1 year (0.3% vs. 0.7%), 5 years (3.1% vs. 4.8%; p=0.26). There were higher rates of revascularization in the PCI cohort at 1 year (10.9% vs. 0.7%) and at 5 years (17.3% vs. 1.5%; p<0.001). There was a trend towards higher cardiovascular events in the PCI group: at 5 years (19.7% vs. 10.9%; p=0.06) driven primarily by repeat revascularization. Conclusions: Revascularization by both PCI and CABG provide excellent mortality results in patients with isolated proximal LAD lesions. Repeat revascularization is more frequent in the PCI group.