The Motivation
Coronary artery disease (CAD) remains a leading cause of mortality worldwide, and the debate over the optimal revascularization strategy—especially for single-vessel left anterior descending (LAD) artery disease—has persisted for decades. While coronary artery bypass grafting (CABG) using the internal mammary artery (IMA) has long been the gold standard, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has gained traction due to its minimally invasive nature. However, conflicting evidence and institutional biases often cloud clinical decision-making. Our team sought to address this gap by comparing mid-term outcomes of CABG-IMA and PCI in a rigorously matched cohort.
The Challenges
One major hurdle was patient selection bias. Cardiologists often lean toward PCI for perceived quicker recovery, while surgeons advocate CABG for durability. To mitigate this, we employed propensity score matching (PSM), ensuring comparable baseline characteristics between groups. Harvesting skeletonized IMA grafts also required meticulous technique to avoid complications, but our prior experience with this method proved invaluable.
Key Findings
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MACCE Rates: CABG showed a significantly lower incidence of major adverse cardiovascular and cerebrovascular events (1.2% vs. 5.3% for PCI, *p* < 0.05), reinforcing the durability of surgical revascularization.
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Mortality: No significant difference in 30-day or 3-year mortality was observed, challenging the notion that PCI is inherently safer.
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Hospital Stay: PCI patients had shorter hospital stays (3.8 vs. 7.7 days), a practical advantage that must be weighed against long-term outcomes.
The Bigger Picture
Our study underscores that CABG-IMA, despite being more invasive, offers superior mid-term outcomes in single-vessel LAD disease. This aligns with biological evidence: IMA grafts have exceptional patency rates due to their resistance to atherosclerosis. Yet, PCI’s shorter recovery time and lower upfront risk make it appealing in shared decision-making.
Limitations and Future Directions
As a single-center study, our results may not generalize broadly. Longer follow-up (beyond 3 years) is needed to assess late graft/stent performance. Additionally, evolving PCI technologies (e.g., bioresorbable stents) could shift the landscape, warranting further research.
Final Thoughts
This paper is a call for collaboration between cardiologists and surgeons. Patient-centered care requires balancing immediate benefits with long-term outcomes. While CABG-IMA remains our preferred choice for LAD disease, individualized treatment plans—guided by heart team discussions—are paramount.