Comparison of Immediate and Long-term Outcomes of Stent vs. Grafts in Proximal LAD Lesions Complicated by TVD

Abstract

Background: The management of triple-vessel disease (TVD) with proximal left anterior descending (PLAD) artery involvement remains a critical challenge in cardiology. Current guidelines advocate for both stent placement and graft surgery, yet evidence supporting the optimal approach is conflicting. Objective This study aims to compare the immediate and long-term outcomes of stent placement versus graft surgery in patients with TVD and PLAD involvement, focusing on all-cause mortality, myocardial infarction (MI), stroke, and major adverse cardiovascular and cerebrovascular events (MACCE). Methods: Conducted at Lady Reading Hospital, Peshawar, from January 2021 to December 2021, this research utilized data from the BEST and SYNTAX randomized controlled trials. The study included patients with at least one lesion causing ≥50% diameter stenosis in the PLAD. Primary outcomes included all-cause death, MI, stroke, and MACCE. Secondary outcomes encompassed cardiac death and all-cause revascularization. Statistical analyses were performed using IBM SPSS Statistics software, version 25, with significance set at a two-sided p-value of less than 0.05. Kaplan-Meier estimates and Cox proportional hazards models were applied for survival analysis, stratified by SYNTAX score. Results: The study encompassed 200 patients (110 in the stent group and 90 in the graft group). Graft surgery was associated with a significantly lower incidence of the combined endpoint of all-cause mortality, MI, and stroke (p < 0.05), as well as reduced rates of MACCE, cardiac death, and all-cause revascularization compared to stent placement. In patients with low SYNTAX scores (≤22), graft surgery was linked with a reduced rate of MI. For those with intermediate to high SYNTAX scores (≥22), graft surgery showed superiority in reducing all-cause death, cardiac death, MI, all-cause revascularization, and MACCE. Conclusion: Graft surgery is superior to stent placement in reducing the incidence of critical adverse events in patients with TVD and PLAD involvement over a five-year follow-up period. These findings underscore the importance of personalized, evidence-based decision-making in the management of complex coronary artery disease.