In Proximal LAD Disease, Stents Favored Over Minimally Invasive Coronary Bypass

Compared with minimally invasive coronary artery bypass grafting (MIDCAB), left anterior descending (LAD) artery stenting offers similar outcomes with shorter hospital stays, according to a new study. However, the results were better in patients with diabetes who had MIDCAB than in those diabetic patients who had stents.

Parents with proximal LAD disease fare equally well after percutaneous coronary intervention (PCI) and after conventional coronary artery bypass grafting but restenosis rates have been higher after PCI, the authors write in the April 15th issue of The American Journal of Cardiology.

Dr. Kazuyuki Shirai and colleagues from Cardiovascular Research Foundation, New York compared the clinical outcomes of coronary stenting (429 patients) versus MIDCAB (152 patients) as treatment for proximal LAD stenosis.

In-hospital major adverse cardiac and cerebrovascular accident rates did not differ significantly for LAD stenting (2.8%) and MIDCAB (1.3%), the authors report, but patients who had LAD stenting experienced significantly shorter stays in the intensive care unit (6.7 versus 24.6 hours, respectively) and in the hospital (2.6 versus 4.1 days, respectively).

Similarly, 6-month all-cause mortality and Q-wave infarction rates did not differ for the two procedures, the report indicates, but there were significantly more repeat revascularizations in the LAD stenting group (13.3% of patients versus 6.6% of MIDCAB patients).

In contrast, the researchers note, in the subgroup of 141 diabetic patients, LAD stenting was associated with a significantly higher 6-month incidence of major adverse cardiac events (18.8%) than was MIDCAB (2.8%), primarily as a result of higher revascularization rates in the stented diabetic patients (15% versus 2.8% in MIDCAB patients).

“For nondiabetics with proximal LAD disease,” the authors conclude, “stenting may be the revascularization strategy of choice.”

“With the increasing availability of drug-eluting stents and their impact on reducing stenosis,” the investigators write, “the differences in revascularization rates between these 2 strategies likely will narrow or disappear, so that stenting will become the optimal treatment for isolated proximal LAD disease in low and higher risk patients. Studies are currently underway to compare these strategies.”

Am J Cardiol 2004;93:959-962.