Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency.
BACKGROUND
The study compared downstream coronary and conduit disease progression in the left anterior descending coronary artery treated with coronary artery bypass grafting using the left internal mammary artery (LIMA) versus percutaneous coronary intervention with bare metal stent (BMS) or drug eluting stent (DES).


RESULTS
A total of 12 301 consecutive patients underwent isolated primary coronary revascularization, of which 2386 met our inclusion criteria (Percutaneous coronary intervention, n=1450; coronary artery bypass grafting, n=936). Propensity score analysis matched 628 patients, of which 468 were treated to the left anterior descending with coronary artery bypass grafting with LIMA (n=314), percutaneous coronary intervention with BMS (n=94), and DES (n=60). Coronary angiograms were analyzed by quantitative coronary angiography (QCA; n=433). Cumulative downstream coronary and conduit disease progression were estimated by Kaplan-Meier method and effect of treatment type by Cox proportional hazard models. Patients treated with LIMA had significantly lower risk of downstream coronary disease progression at follow-up angiogram compared with BMS and DES (hazard ratio [HR] [95% CI], 0.34; [0.20-0.59]; P=0.0002; and HR [95% CI], 0.39; [0.20-0.79]; P=0.01, respectively). LIMA was associated with a lower risk of conduit disease progression compared to BMS and DES (HR [95% CI], 0.18; [0.12-0.28]; P<0.001; and HR [95% CI], 0.27; [0.16-0.46]; P<0.001, respectively). BMS was associated with higher HR for downstream coronary and conduit disease progression compared with DES, but the difference did not reach statistical significance (HR [95% CI], 1.13; [0.57-2.36]; P=0.73; and HR [95% CI], 1.46; [0.88-2.50]; P=0.14, respectively).


CONCLUSIONS
LIMA grafting to left anterior descending is associated with significantly lower risk of downstream coronary and conduit disease progression compared to percutaneous coronary intervention with BMS and DES.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Ming
M
Zhang
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Raviteja R
RR
Guddeti
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Yasushi
Y
Matsuzawa
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Jaskanwal D S
JD
Sara
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Taek-Geun
TG
Kwon
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Zhi
Z
Liu
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Tao
T
Sun
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Seung-Jin
SJ
Lee
Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, MN.
Ryan J
RJ
Lennon
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Malcolm R
MR
Bell
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
Hartzell V
HV
Schaff
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
Richard C
RC
Daly
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Lilach O
LO
Lerman
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN lerman.amir@mayo.edu lekerlocker.chaim@mayo.edu.
Amir
A
Lerman
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN lerman.amir@mayo.edu lekerlocker.chaim@mayo.edu.
Chaim
C
Locker
bare metal stent; conduit stenosis; coronary disease; drug eluting stent; left internal mammary artery; revascularization
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