OR4-2 | Percutaneous Coronary Intervention Versus Robotic-Assisted Coronary Artery Bypass for Left Anterior Descending Artery Chronic Total Occlusion

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. 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. 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). 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.