Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598805
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Monday, February 13th, 2017
DGTHG: Coronary Heart Disease: Off-pump ./. On-pump
Georg Thieme Verlag KG Stuttgart · New York

Long-term Survival, Freedom from Re-intervention and Costs after MIDCAB Compared to PCI on the LAD

M. Zeriouh
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
A. Sabashnikov
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Y.H. Choi
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
A.C. Deppe
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
N. Mader
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
P. Rahmanian
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
M. Scherner
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
J. Fatullayev
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
R. Pfister
2   Heart Center, Department of Cardiology, Pneumology and Angiology, University of Cologne, Cologne, Germany
,
J. Wippermann
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
G. Michels
2   Heart Center, Department of Cardiology, Pneumology and Angiology, University of Cologne, Cologne, Germany
,
T. Wahlers
1   Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

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Objective: Outcomes and treatment costs for coronary artery disease involving left artery descending (LAD) are influenced by the type of treatment that can be either isolated minimally invasive revascularization of the LAD using the internal thoracic artery (ITA) (MIDCAB) or percutaneous coronary intervention (PCI) on the LAD. This retrospective study sought to evaluate long-term survival, freedom from re-intervention and costs after MIDCAB compared with PCI on the LAD.

Methods: Between 2006 and 2012, 106 consecutive patients with LAD stenosis underwent MIDCAB procedure whereas 100 patients underwent elective PCI. Urgent and emergent cases (n = 355) were excluded from the present study. Detailed analysis of outcome data was performed for both groups. A Kaplan-Meier survival estimation with up to 10-year follow-up was applied for both groups for survival analysis and freedom from re-intervention.

Results: There were no statistically significant differences in terms of clinically relevant baseline characteristics. The outcome in the MIDCAB group was superior regarding long-term overall survival accounting for 100 versus 92.8% at 1 year, 98.5 versus 82.1% at 6 years, and 79.6 versus 61.5% at 10 years (log tank (Mantel-Cox) p = 0.011) and freedom from re-intervention at 10 years (97.2 vs. 86.7%, log rank (Mantel-Cox) p = 0.001). ICU stay (p = 0.020) and total hospital stay (p < 0.001) were significantly longer in the MIDCAB group that was also associated with higher costs (10,879 € vs. 4,009 €, p < 0.001).

Conclusion: Whereas patients undergoing MIDCAB remain longer on ICU and in hospital causing higher costs, this procedure is associated with a significantly lower incidence of repeat revascularization and significantly lower mortality compared with PCI on the LAD.