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 e...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-09-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://doi.org/10.1161/JAHA.116.003568 |
| _version_ | 1819092108664897536 |
|---|---|
| author | Ming Zhang Raviteja R. Guddeti Yasushi Matsuzawa Jaskanwal D.S. Sara Taek‐Geun Kwon Zhi Liu Tao Sun Seung‐Jin Lee Ryan J. Lennon Malcolm R. Bell Hartzell V. Schaff Richard C. Daly Lilach O. Lerman Amir Lerman Chaim Locker |
| author_facet | Ming Zhang Raviteja R. Guddeti Yasushi Matsuzawa Jaskanwal D.S. Sara Taek‐Geun Kwon Zhi Liu Tao Sun Seung‐Jin Lee Ryan J. Lennon Malcolm R. Bell Hartzell V. Schaff Richard C. Daly Lilach O. Lerman Amir Lerman Chaim Locker |
| author_sort | Ming Zhang |
| collection | DOAJ |
| description | 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). Methods and 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. |
| first_indexed | 2024-12-21T22:50:23Z |
| format | Article |
| id | doaj.art-2ecbb51583c646cdafdcb93d521e32f5 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-21T22:50:23Z |
| publishDate | 2016-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-2ecbb51583c646cdafdcb93d521e32f52022-12-21T18:47:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-09-0159n/an/a10.1161/JAHA.116.003568Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit PatencyMing Zhang0Raviteja R. Guddeti1Yasushi Matsuzawa2Jaskanwal D.S. Sara3Taek‐Geun Kwon4Zhi Liu5Tao Sun6Seung‐Jin Lee7Ryan J. Lennon8Malcolm R. Bell9Hartzell V. Schaff10Richard C. Daly11Lilach O. Lerman12Amir Lerman13Chaim Locker14Division of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Biomedical Statistics and Informatics Mayo College of Medicine Rochester MNDivision of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Cardiovascular Surgery Mayo Clinic Rochester MNDivision of Cardiovascular Surgery Mayo Clinic Rochester MNDivision of Nephrology and Hypertension Mayo Clinic Rochester MNDivision of Cardiovascular Diseases Mayo Clinic Rochester MNDivision of Cardiovascular Surgery Mayo Clinic Rochester MNBackground 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). Methods and 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.https://doi.org/10.1161/JAHA.116.003568bare metal stentconduit stenosiscoronary diseasedrug eluting stentleft internal mammary arteryrevascularization |
| spellingShingle | Ming Zhang Raviteja R. Guddeti Yasushi Matsuzawa Jaskanwal D.S. Sara Taek‐Geun Kwon Zhi Liu Tao Sun Seung‐Jin Lee Ryan J. Lennon Malcolm R. Bell Hartzell V. Schaff Richard C. Daly Lilach O. Lerman Amir Lerman Chaim Locker Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease bare metal stent conduit stenosis coronary disease drug eluting stent left internal mammary artery revascularization |
| title | Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency |
| title_full | Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency |
| title_fullStr | Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency |
| title_full_unstemmed | Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency |
| title_short | Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency |
| title_sort | left internal mammary artery versus coronary stents impact on downstream coronary stenoses and conduit patency |
| topic | bare metal stent conduit stenosis coronary disease drug eluting stent left internal mammary artery revascularization |
| url | https://doi.org/10.1161/JAHA.116.003568 |
| work_keys_str_mv | AT mingzhang leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT ravitejarguddeti leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT yasushimatsuzawa leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT jaskanwaldssara leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT taekgeunkwon leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT zhiliu leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT taosun leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT seungjinlee leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT ryanjlennon leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT malcolmrbell leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT hartzellvschaff leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT richardcdaly leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT lilacholerman leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT amirlerman leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency AT chaimlocker leftinternalmammaryarteryversuscoronarystentsimpactondownstreamcoronarystenosesandconduitpatency |