UAlbany Study: Bypass Revascularization Rates Significantly Lower for Patients with PLAD Coronary Artery Disease

ALBANY, N.Y. (January 29, 2015) – A new University at Albany-led study has found that revascularization rates for patients who underwent coronary artery bypass graft (CABG) surgery for isolated (single vessel) proximal left anterior descending (PLAD) coronary artery disease was significantly lower than patients who underwent percutaneous coronary interventions (PCIs) in the era of drug-eluting stents (DES).

A new UAlbany-led study found no difference in the mortality rates of PLAD patients who underwent bypass procedures as compared to precutaneous cornary interventions.

The analysis, led by Distinguished Professor Emeritus of Public Health Edward L. Hannan, and published in the December 2014 issue of the Journal of the American College of Cardiology, examined data from two New York state registries: the Percutaneous Coronary Interventions Reporting System and the Cardiac Surgery Reporting System. The study included 6,064 patients who underwent revascularization (CABG surgery or DES) for single-vessel proximal LAD disease at 57 hospitals from 2008 through 2010; 88 percent underwent PCI with DES and the rest underwent CABG.

At three years, patients who received DES had lower unadjusted rates of all-cause mortality (4.3 percent vs 5.9 percent) and a composite of mortality, heart attack (myocardial infarction/MI), or stroke (6.1 percent vs 8.3 percent), but higher rates of repeat revascularization (12.2 percent vs 6.5 percent). But after propensity matching, which left 715 patients each who underwent PCI or CABG, there were no differences in hard clinical outcomes, although repeat revascularization rates remained lower with CABG.

The findings were similar in analyses restricted to diabetic patients and to those with no history of MI. Patients who received DES were more likely to be female, nonwhite or nonblack, have a higher BMI and ejection fraction, and were less likely to have a history of MI, cerebrovascular disease, peripheral vascular disease, congestive HF, chronic obstructive pulmonary disease or malignant ventricular arrhythmia.

"Most patients (88 percent) with isolated proximal left anterior descending disease undergo PCI. Despite the fact that current guidelines have a stronger rating for CABG for these patients, there were no differences between CABG and DES in mortality or mortality, MI and/or stroke," the researchers concluded.

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