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ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 4  |  Page : 174-180

Twelve months outcome of drug-eluting stenting versus off-pump bypass surgery for proximal left anterior descending coronary artery lesion in ischemic cardiomyopathy


1 Department of Cardiology, Zagazig University, Zagazig, Egypt
2 Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
3 Department of Anesthesiology, Cairo University, Cairo, Egypt

Correspondence Address:
Dr. Yasser Gaber Metwally
Department of Cardiology, Zagazig University, Zagazig
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JICC.JICC_51_20

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Background: The precise benefit/risk ratio of either procedure in patients with ischemic cardiomyopathy remains less clear. Objectives: This study is aimed to assess the 12 months outcome of drug-eluting stent (DES) versus off-pump CABG (OPCAB) for proximal left anterior descending lesions in ischemic cardiomyopathy. Patients and Methods: A total of 70 patients diagnosed with ischemic cardiomyopathy with ejection fraction <35% referred for revascularization were assigned to either stenting or surgery. The primary endpoint was (in stent restenosis [ISR]/graft occlusion) rates; the secondary endpoint was MACE at 12 months of follow-up. Results: Out of 70 patients enrolled; 71.4% were assigned to DES, while 28.6% were assigned to OPCAB; the mean the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery score for stent group was 17.5 ± 0.96, while the mean Euro-score II for the surgery group was 3 ± 0.86. The ISR/graft occlusion rates; angina; and target vessel revascularization were significantly higher among the stenting group (30% vs. 5%; P = 0.028); (4% vs. 25%; P = 0.017) and (22% vs. 0%, P = 0.028), respectively, while late transient ischemic attack/stroke and length of hospital stay were significantly higher among the surgery group (2% vs. 20%; P = 0.021) and (2 ± 0.5 days vs. 7.2 ± 0.5, P < 0.001), respectively; similar survival rates among the two groups. The relative risk of ISR/graft occlusion is six times more among the stent group compared to the surgery group (P = 0.028). Conclusion: Similar survival rates at 12 months of follow-up among the two groups; stent carries more risk of ISR; repeat revascularization while surgery carries more risk of late stroke.


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