title: Minimally invasive direct coronary artery bypass improves late survival compared with drug-eluting stents in isolated proximal left anterior descending artery disease: a 10-year follow-up, single-center, propensity score analysis.
abstract: OBJECTIVE
  Minimally invasive direct coronary artery bypass (MIDCAB) has been proposed to reduce surgical morbidity and improve long-term outcomes compared with stenting in the treatment of isolated proximal left anterior descending artery. However, the survival benefit from MIDCAB still needs to be demonstrated, in particular, because percutaneous coronary intervention with drug-eluting stents (DES-PCI) continues to be considered the initial treatment strategy. We conducted a 10-year follow-up, single-center, propensity score-matched MIDCAB versus DES-PCI comparison.
  
  
  METHODS
  A total of 1033 patients (303 MIDCAB and 730 DES-PCI) with isolated proximal left anterior descending disease were included. Propensity score matching was used to compare 303 pairs of MIDCAB and DES-PCI patients.
  
  
  RESULTS
  MIDCAB and DES-PCI presented with comparable 30-day mortality (2 of 303 [0.6%] vs 1 of 303 [0.3%]; P=1.0). At 10 years, DES-PCI was associated with a 2.19-fold increased risk of late death (95% confidence interval, 1.15-4.17), a 2.0-fold increased risk of repeat revascularization (95% confidence interval, 1.20-3.47), and a 2.14-fold increased risk of the composite of death and repeat revascularization (95% confidence interval, 1.41-3.24).
  
  
  CONCLUSIONS
  These findings strongly support a survival benefit from MIDCAB at long-term follow-up compared with DES-PCI in the treatment of isolated left anterior descending disease.
authors: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom. Electronic address: umberto.benedetto@hotmail.com.
authors: Umberto
authors: U
authors: Benedetto
authors: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors: Shahzad G
authors: SG
authors: Raja
authors: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors: Rafik F B
authors: RF
authors: Soliman
authors: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors: Alberto
authors: A
authors: Albanese
authors: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors: Anand
authors: A
authors: Jothidasan
authors: Department of Cardiology, Harefield Hospital, London, United Kingdom.
authors: Charles D
authors: CD
authors: Ilsley
authors: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors: Mohamed
authors: M
authors: Amrani
mesh_terms: D000368:Aged; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D017239:Paclitaxel / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage; D015996:Survival Rate; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage
chemical_list: D007166:Immunosuppressive Agents; D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus