OR04-2
Percutaneous Coronary Intervention Versus Robotic-Assisted Coronary Artery Bypass for Left Anterior Descending Artery Chronic Total Occlusion
Presenter
Elsa Hebbo, MD, Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
Elsa Hebbo, MD1, Giancarlo Licitra, MD, MPH1, Bryan Kindya, MD1, Malika Elhage Hassan, MD1, Nikoloz Shekiladze, MD1, Pratik B Sandesara, MD1, William J. Nicholson, M.D.1, Michael E. Halkos, MD, MSc2 and Wissam A Jaber, M.D., FSCAI2, (1)Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, (2)Emory University Hospital, Atlanta, GA
Keywords: Chronic Total Occlusion (CTO), Coronary and Stable Ischemic Heart Disease (SIHD)
Background
Both percutaneous coronary interventions (PCI) and robotic-assisted coronary artery bypass surgery (CAB) can provide left anterior descending (LAD) chronic total occlusion (CTO) revascularization. We compare long term clinical outcomes between the two strategies.
Methods
We retrospectively analyzed a total of 273 CTO patients who underwent either PCI (129) or CAB (144) at a single institution. Long-term follow up was available for 96 PCI and 125 CAB patients. Cumulative survival analyses, survival free of myocardial infarction (MI) and repeat revascularization were performed using Kaplan-Meier curves and log-rank test.
Results
PCI patients had more comorbidities including diabetes (48.9% vs 24.6%; p < 0.001), lower ejection fraction (EF, 44 ± 14 vs 52 ± 10; p < 0.001), prior heart failure (36.6 % vs 22.2%; p = 0.02), and prior bypass surgery (0 vs 16%, p<0.001).
PCI to non-LAD vessel was performed as part of initial complete revascularization in 40.3% of PCI and 40.6% of CAB patients. On follow up (median 3.4 years), PCI patients had similar unadjusted mortality, but higher MI and repeat revascularization compared to CAB (Figure). An unadjusted cox-proportional model showed a higher risk of repeat revascularization for PCI patients (HR 7.0, 95% CI 2.53-19.4) however this association was attenuated after adjusting for EF, diabetes and prior bypass (HR 2.2, CI 0.6-7.6).
Conclusions
In patients with LAD CTO, both PCI and CAB resulted in comparable rates of all-cause mortality. Patients undergoing PCI had higher rates of MI and repeat revascularization, at least in part due to their higher comorbidities.
