MACE Rate after MIDCAB and PCI in single vessel disease: 5 years follow-up of a randomized trial

Objectives: At 6 months follow-up MIDCAB surgery showed a significantly lower reintervention rate, no neurological defects and similar results for mortality and reinfarctions in comparison to PCI (percutaneous transluminal intervention) plus stenting in patients with isolated proximal LAD lesions. After 5 years follow up, the MACE rate is lower compared to PCI.

Methods: Initially 220 patients with isolated proximal LAD stenosis were randomized either to MIDCAB (n=110) or stenting (n=110). After 5 years patients or their general practitioner were contacted by telephone with respect to MACE rate. Clinical symptoms were assessed by the CCS-classification.

Results: Follow-up could be obtained for 98.2% with a mean follow-up of 5.8±0.9 years. With respect to mortality (MIDCAB 11.8%, Stent 10.0%, p=0.83) there were no differences for both treatment strategies but a tendency towards lower reinfarctions in the MIDCAB group (MIDCAB 2.7%; Stent 4.5%, p=0.72). Reinterventions of the target lesion and other lesions were significantly higher with 35.5% after stenting (MIDCAB 13.6%; p<0.001). Overall MACE rate was lower in the MIDCAB group (MIDCAB 29% vs. Stenting 47%; p=0.02). Clinical symptoms improved significantly in both groups in comparison to baseline, but more favorably with MIDCAB procedure (Stenting: CCS 2.6±0.9 to 0.6±0.8, p<0.001 vs. baseline; MIDCAB: 2.6±0.9 to 0.3±0.6; p<0.001 vs. baseline, p=0.01 vs. Stent).

Conclusion: At 5 years follow-up, MIDCAB as well as PCI plus bare-metal stent, show good results. Nevertheless, the MACE rate especially the reintervention rate is significantly higher in the stenting group an