title: Coronary artery bypass graft surgery versus drug-eluting stents for patients with isolated proximal left anterior descending disease.
abstract: BACKGROUND
  Few recent studies have compared the outcomes of coronary artery bypass graft (CABG) surgery with percutaneous coronary interventions (PCIs) in patients with isolated (single vessel) proximal left anterior descending (PLAD) coronary artery disease in the era of drug-eluting stents (DES).
  
  
  OBJECTIVE
  The goal of this study was to compare outcomes in patients with PLAD who underwent CABG and PCI with DES.
  
  
  METHODS
  New York's Percutaneous Coronary Interventions Reporting System was used to identify and track all patients who underwent CABG surgery and received DES for isolated PLAD disease between January 1, 2008 and December 31, 2010, and who were followed-up through December 31, 2011. A total of 5,340 of 6,064 (88%) patients received DES. Patients were matched to vital statistics data to obtain mortality after discharge and matched to New York's administrative data to obtain readmissions for myocardial infarction (MI) and stroke. To minimize selection bias, patients were propensity matched into 715 CABG and/or DES pairs, and 3 outcome measures were compared across the pairs.
  
  
  RESULTS
  Kaplan-Meier estimates for CABG and DES did not significantly differ for mortality or mortality, MI, and/or stroke, but repeat revascularization rates were lower for CABG (7.09% vs. 12.98%; p = 0.0007). After further adjustment with Cox proportional hazards models, there were still no significant differences in 3-year mortality rates (CABG and/or DES adjusted hazard ratio (AHR): 1.14; 95% confidence interval [CI]: 0.70 to 1.85) or mortality, MI, and/or stroke rates (AHR: 1.15; 95% CI: 0.76 to 1.73), and the repeat revascularization rate remained significantly lower for CABG patients (AHR: 0.54; 95% CI: 0.36 to 0.81).
  
  
  CONCLUSIONS
  Despite the higher rating in current guidelines of CABG (Class IIa vs. Class IIb) for patients with isolated PLAD disease, there were no differences in mortality or mortality, MI, and/or stroke, although CABG patients had significantly lower repeat revascularization rates.
authors.affiliation: University at Albany, State University of New York, Albany, New York. Electronic address: elh03@health.state.ny.us.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.affiliation: University at Albany, State University of New York, Albany, New York.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhong
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Gary
authors.initials: G
authors.lastname: Walford
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.affiliation: Albany Medical Center, Albany, New York.
authors.forename: Ferdinand J
authors.initials: FJ
authors.lastname: Venditti
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.affiliation: Boston Medical Center, Boston, Massachusetts.
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.affiliation: United Health Services, Binghamton, New York.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Stamato
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: Mount Sinai Medical Center, New York, New York.
authors.forename: Samin
authors.initials: S
authors.lastname: Sharma
authors.affiliation: St. Joseph's Health System, Atlanta, Georgia.
authors.forename: Spencer B
authors.initials: SB
authors.lastname: King
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016896:Treatment Outcome
keywords: CABG surgery; PCI; outcomes; proximal left anterior descending disease