Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

Abstract

Background-Randomized trials comparing stenting with minimally invasive direct coronary artery bypass surgery in patients with isolated proximal left anterior descending lesions have shown a significantly higher reintervention rate for stenting and similar results for mortality and reinfarction at short-term follow-up. Long-term follow-up data are sparse. Methods and Results-Patients with isolated proximal left anterior descending stenosis were randomized to either surgery (nϭ110) or bare-metal stenting (nϭ110). At 5 years, follow-up data were obtained with respect to the primary end point of death, reinfarction, or repeated target vessel revascularization. Clinical symptoms were assessed by the Canadian Cardiovascular Society (CCS) classification. Follow-up information was completed for 216 patients (98.2%), and mean follow-up was 5.6Ϯ1.2 years. With respect to mortality (surgery, 12%; stenting, 10%; Pϭ0.54) and reinfarctions (surgery, 7%; stenting, 5%; Pϭ0.46), there were no differences between treatment strategies. The need for repeated target vessel revascularization was significantly higher after stenting (32%) compared with surgery (10%; PϽ0.001).Clinical symptoms improved significantly in both treatment groups compared with baseline; however, there was a favorable trend for surgery (stenting: CCS, 2.6Ϯ0.9 to 0.5Ϯ0.8, PϽ0.001; surgery: CCS, 2.6Ϯ0.9 to 0.3Ϯ0.6, PϽ0.001; Pϭ0.05, stenting versus surgery). Conclusions-At the 5-year follow-up, minimally invasive bypass surgery and bare-metal stenting showed similar results for the end points of mortality and reinfarctions. However, the reintervention rate is higher after stenting, and the relief in clinical symptoms is slightly better after surgery. (Circulation. 2005;112:3445-3450.)

Randomized Comparison of Minimally Invasive Direct Coronary Artery Bypass Surgery Versus Sirolimus-Eluting Stenting in Isolated Proximal Left Anterior Descending Coronary Artery Stenosis

“…Both treatment strategies effectively reduce symptoms (3). Randomized trials comparing both strategies revealed a significantly higher reintervention rate after stenting and similar results for mortality and reinfarction at mid-to long-term follow-up (4,5).…”

Coronary artery bypass grafting without full sternotomy

“…It is well known that LITA-LAD bypass is superior to PCI in terms of the need for reintervention. According to various reports, revascularization after PCI/MIDCAB was required for 13.3-27.9/6.6%-8.4% of patients at 6 months, 5,21 16.2/4.2% at 1 year, 47 24.2/0% at 3.4 years, 48 and 32/10% at 5 years. 49 A relatively new drug-eluting stent is now used for such patients to prevent restenosis of the targeted lesion.…”

The Role of Revascularization Versus Medical Therapy in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease

“…However, in patients with normal left ventricular systolic function and single-or two-vessel CAD not involving the left anterior descending coronary artery (LAD), there is no evidence to suggest that CABG is beneficial over PCI [20••]. In patients with proximal LAD disease, PCI with BMS and CABG (including minimally invasive CABG) appear to be equivalent in terms of mortality benefit, although there is a lower rate of repeat revascularization with CABG [45][46][47][48]. Nonetheless, in the modern era of PCI with DES, the repeat revascularization advantage of CABG over PCI may be reduced or nonexistent in patients with proximal LAD disease.…”