title: Outcomes of revascularization strategies for two-vessel coronary artery disease involving the proximal left anterior descending artery in an era of improved pharmacotherapy and stenting.
abstract: BACKGROUND
  The best therapeutic strategy for patients with double-vessel coronary artery disease and proximal left anterior descending artery involvement (2VD + pLAD) is not clear.
  
  
  OBJECTIVE
  To compare the survival experience of a cohort of cardiac catheterization patients with 2VD + pLAD based on chosen therapeutic strategy (medical management versus percutaneous coronary intervention [PCI] versus coronary artery bypass graft surgery [CABG]).
  
  
  METHODS
  The authors identified and studied a total of 603 patients with 2VD + pLAD from all patients who underwent diagnostic coronary angiography in Alberta between January 1997 and May 1999. The primary end point was five-year survival from index catheterization for each of the treatment groups and from time of revascularization when the two revascularization strategies were compared.
  
  
  RESULTS
  Risk-adjusted hazard ratios (HR) comparing cumulative five-year survival rates of patients treated medically, or with PCI or CABG indicated a survival benefit for patients treated with CABG (HR 0.24, 95% CI 0.11 to 0.54; P<0.001) and PCI (HR 0.43, 95% CI 0.24 to 0.77; P=0.003) compared with medical management. Meanwhile, a risk-adjusted comparison of revascularization strategies suggested a possible trend toward higher mortality for PCI-treated patients versus CABG-treated patients (HR 1.56, 95% CI 0.65 to 3.72; P=0.125).
  
  
  CONCLUSIONS
  The results of this registry-based observational study suggest a survival benefit from revascularization compared with medical management in patients with 2VD + pLAD. Furthermore, the authors found a trend toward better survival in CABG-treated patients compared with PCI-treated patients.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Hubacek
authors.forename: Sunil
authors.initials: S
authors.lastname: Kalla
authors.forename: P Diane
authors.initials: PD
authors.lastname: Galbraith
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Graham
authors.forename: Merril L
authors.initials: ML
authors.lastname: Knudtson
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D015607:Stents; D015996:Survival Rate