Key result
Minimally invasive CABG shows similar 4-year MACCE rates compared to conventional CABG.
Why the study?
The study was designed to compare clinical outcomes in CAD patients undergoing minimally invasive coronary artery bypass grafting surgery versus conventional CABG.
Does minimally invasive coronary artery bypass grafting surgery reduce major adverse cardiac and cerebrovascular events in patients with coronary artery disease compared to conventional coronary artery bypass grafting?
Cohort (n=679)
No
Does minimally invasive coronary artery bypass grafting surgery reduce major adverse cardiac and cerebrovascular events in patients with coronary artery disease compared to conventional coronary artery bypass grafting?
Hazard Ratio: 1.33 (95% CI 0.33–5.39)
Absolute Event Rate: 7.6% vs 9.3%
p-value: p=0.687
Minimally invasive coronary artery bypass grafting surgery achieves similar clinical outcomes to conventional CABG in patients with coronary artery disease.
MICS linked to similar MACCE rates versus CABG; hypothesis-generating for equivalence, RCTs needed before practice change.
Background: This present research was designed for comparing coronary artery disease (CAD) patient outcomes following minimally invasive coronary artery bypass grafting surgery (MICS) or coronary artery bypass grafting (CABG).Methods: From 2014-2017, 679 CAD patients underwent MICS (n=281) or CABG (n=398) and were evaluated for the present study.Patient data were analyzed using 1:1 propensity score-matched assessment and a multivariate Cox proportional hazards regression model, and primary study achievements comprised major adverse cardiac and cerebrovascular events (MACCEs), myocardial infarction (MI), cardiac death, heart failure (HF), revascularization, and stroke.The median follow-up period was 2.68 years.Results: CABG patients exhibited a trend towards higher cumulative overall rates of MACCEs at 2 years (CABG: 6.2% vs. MICS: 3.8%) and 4 years (CABG: 9.3% vs. MICS: 7.6%) [adjusted hazard ratio (HR):1.33; 95% confidence interval (CI): 0.33-5.39for CABG vs. MICS; P=0.687], although this difference was not significant.No significant differences in 2-or 4-year cardiac death rates were observed between groups (CABG: 3.5%, 5.6% vs. MICS 2.8%, 2.8%; adjusted HR: 0.23; 95% CI: 0.03-1.81for CABG vs. MICS; P=0.160).Further, there existed no discrepancies in rates of MI (P=1.000),HF (adjusted HR: 4.76; 95% CI: 0.01-6.40for CABG vs. MICS; P=0.996), stroke (adjusted HR: 9.58; 95% CI: 0.11-25.24for CABG vs. MICS; P=0.320), or repeated revascularization (adjusted HR: 1.71; 95% CI: 0.01-7.21for CABG vs. MICS; P=0.631) when comparing these patient groups.In a multivariable Cox proportional hazards regression analysis, patients that were male (adjusted HR: 5.28; 95% CI: 1.48-18.83;P=0.010) and cases with a history of previous MI epsiodes (adjusted HR: 3.20; 95% CI: 1.09-9.37;P=0.034) were found to be at a higher risk of MACCEs.Conclusions: Follow-up data indicated that the MICS and CABG treatments could achieve similar outcomes.
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Lin et al. (2022) conducted a cohort in Coronary artery disease (CAD) (n=679). Minimally invasive coronary artery bypass grafting surgery (MICS) vs. Coronary artery bypass grafting (CABG) was evaluated on Major adverse cardiac and cerebrovascular events (MACCEs) at 4 years (HR 1.33, 95% CI 0.33-5.39, p=0.687). Minimally invasive coronary artery bypass grafting had similar 4-year rates of MACCEs compared to conventional CABG (7.6% vs. 9.3%; HR 1.33 for CABG vs MICS, 95% CI 0.33-5.39; P=0.687).
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