title: Five-year follow-up of drug-eluting stents implantation vs minimally invasive direct coronary artery bypass for left anterior descending artery disease: a propensity score analysis.
abstract: OBJECTIVE
  The spread of drug-eluting stents (DES) has reduced the incidence of early restenosis following percutaneous coronary interventions (PCI). Meanwhile, development of minimally invasive coronary artery bypass surgery (MIDCAB) has offered a valuable alternative to conventional sternotomy with preservation of the benefit of the internal mammary artery use. Therefore, the revascularization of the left anterior descending (LAD) artery is suitable for both techniques. However, few data with long-term comparison of these two techniques exist.
  
  
  METHODS
  Prospective data were collected for 456 patients undergoing isolated LAD revascularization between 1997 and 2011. Two hundred and sixty patients were treated with MIDCAB and 196 with first-generation DES implantation. A propensity score model was created to adjust for 19 relevant confounding variables. Primary and secondary end-points were, respectively, 5-year survival and freedom from major adverse cerebro-cardiovascular events (MACCE).
  
  
  RESULTS
  Both groups were similar in age, EuroSCORE and mean duration of follow-up. Five-year survival was similar after MIDCAB or DES (hazard ratio (HR): 0.95; P = 0.89). Freedom from MACCE was significantly in favour of the MIDCAB group (HR: 0.32, P < 0.0001), mainly triggered by high subsequent need for revascularization of the targeted vessel in the DES group (HR: 0.17, P < 0.0001).
  
  
  CONCLUSIONS
  MIDCAB and DES implantation showed similar rates of survival but despite an expected lower rate of reintervention on the targeted vessel with DES use, a highly significant higher MACCE rate was observed in the PCI group at 5-year follow-up.
authors.affiliation: Clinique St Luc, Namur, Belgium.
authors.forename: Pierre Yves
authors.initials: PY
authors.lastname: Etienne
authors.forename: William
authors.initials: W
authors.lastname: D'hoore
authors.forename: Spiridon
authors.initials: S
authors.lastname: Papadatos
authors.forename: Yves
authors.initials: Y
authors.lastname: Mairy
authors.forename: Gebrine
authors.initials: G
authors.lastname: El Khoury
authors.forename: Philippe
authors.initials: P
authors.lastname: Noirhomme
authors.forename: Claude
authors.initials: C
authors.lastname: Hanet
authors.forename: David
authors.initials: D
authors.lastname: Glineur
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications; D057216:Propensity Score
keywords: Bypass; Coronary disease; Internal thoracic artery; Stent; Surgery