Isolated LAD revascularization in the modern era: Demographics and preliminary outcomes

Revascularization of the left anterior descending coronary artery is an imp ortant, evolving and controversial topic. There are differences in patient selection, hospital stay and readmission, and hospital cost. We reviewed our institutional experience in 190 consecutive patients who un derwent isolated initial left anterior descending revascularization via ang ioplasty, angioplasty plus stenting, conventional coronary artery bypass gr afting and minimally invasive direct coronary artery bypass. We sought to d etermine if there were differences in patient demographics, clinical outcom es, and resource utilization. We sought to evaluate what were the principal determinants of any measured differences in outcome. Inpatient and outpatient chart review, evaluation of hospital cost via micr o cost method, and multivariate analysis were employed. Results with p < 0. 05 were considered significant by conventional statistical analysis. Mortality was equal in all subgroups. Patients who underwent percutaneous r evascularization had a shorter initial length of hospital stay and initial hospital cost. This was particularly true among those who received stents, Patients who received surgical therapy were less Likely to require repeat h ospital admission for both cardiac and noncardiac indications. During follo w up, the initial resource savings attributable to percutaneous interventio ns dissipated. Multivariate analysis indicated that measured differences we re likely attributable to differences in patient baseline demographics rath er than the choice of revascularization procedure. Though there are differences in resources, as measured by hospital days or hospital costs between patients undergoing LAD revascularization via differ ent techniques, the differences are principally due to differences in the t ypes of patients selected for these techniques rather than the revasculariz ation procedure.