CLINICAL STUDY
A prospective randomized trial comparing stenting with off-pump coronary surgery for high-grade stenosis in the proximal left anterior descending coronary artery
three-year follow-up
Derk J. Drenth, MD*,
Nic J. G. M. Veeger, Msc*,
Jobst B. Winter, MD, PhD*,
Jan G. Grandjean, MD, PhD, FECTS ,
Massimo A. Mariani, MD, PhD,
A. d J. Boven van, MD, PhD* and
Piet W. Boonstra, MD, PhD, FECTS*,*
* Thoraxcentre of the Groningen University Hospital, Groningen, the Netherlands
Thoraxcentre of the Pisa University Hospital, Pisa, Italy
Manuscript received May 17, 2002;
revised manuscript received July 18, 2002,
accepted July 24, 2002.
* Reprint requests and correspondence: Dr. Piet W. Boonstra, Department of Cardiothoracic Surgery, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands.
p.w.boonstra{at}thorax.azg.nl
OBJECTIVES: This study was done to identify the best treatment for an isolated high-grade stenosis of the proximal left anterior descending coronary artery (LAD).
BACKGROUND: Percutaneous transluminal coronary angioplasty with stenting (PCI) and off-pump coronary artery bypass grafting (surgery) are used to treat single-vessel disease of a high-grade stenosis of the proximal LAD. Midterm results of both treatments are compared in this prospective randomized study.
METHODS: In a single-center prospective trial, we randomly assigned 102 patients with a high-grade stenosis of the proximal LAD (American College of Cardiology/American Heart Association classification type B2 or C) to PCI (n = 51) or surgery (n = 51). Primary composite end point was freedom from Major Adverse Cardiac and Cerebrovascular Events (MACCE) at follow-up, including death, myocardial infarction, cerebrovascular accident, and repeat target vessel revascularization (TVR). Secondary end points were angina pectoris class and need for antianginal medication at follow-up. Analysis was by intention-to-treat (ITT) and received treatment (RT).
RESULTS: Mean follow-up time was three years (90% midrange, two to four years). Incidence of MACCE was 23.5% after PCI and 9.8% after surgery; p = 0.07 ITT (24.1% vs. 8.3%; p = 0.04 RT). After surgery a significantly lower angina pectoris class (p = 0.02) and need for antianginal medication (p = 0.01) was found compared to PCI. Target vessel revascularization was 15.7% after PCI and 4.1% after surgery (p = 0.09).
CONCLUSIONS: At three-year follow-up (range, two to four years), a trend in favor of surgery is observed in regard to MACCE-free survival with a significantly lower angina pectoris status and significantly lower need for antianginal medication.
|
Abbreviations and Acronyms
| | CABG | | coronary artery bypass grafting | | Gp | | glycoprotein | | LAD | | left anterior descending coronary artery | | MACCE | | major adverse cardiac and cerebrovascular events | | PCI | | percutaneous transluminal coronary angioplasty with stenting | | surgery | | off-pump coronary artery bypass grafting with a left internal mammary artery to the left anterior descending coronary artery | | TVR | | repeat target vessel revascularization |
|
This article has been cited by other articles:
|
|
|
|
 
J. R. Kapoor, A. L. Gienger, R. Ardehali, R. Varghese, M. V. Perez, V. Sundaram, K. M. McDonald, D. K. Owens, M. A. Hlatky, and D. M. Bravata
Isolated Disease of the Proximal Left Anterior Descending Artery: Comparing the Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Surgery
J. Am. Coll. Cardiol. Intv.,
October 1, 2008;
1(5):
483 - 491.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. T. Newsome, M. A. Kutcher, and R. L. Royster
Coronary Artery Stents: Part I. Evolution of Percutaneous Coronary Intervention
Anesth. Analg.,
August 1, 2008;
107(2):
552 - 569.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Shuhaiber and J. Reston
Time to Intervention During Cardiac Interventions. Are We Forgetting a Confounder?
Asian Cardiovasc Thorac Ann,
February 1, 2008;
16(1):
1 - 3.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Bravata, A. L. Gienger, K. M. McDonald, V. Sundaram, M. V. Perez, R. Varghese, J. R. Kapoor, R. Ardehali, D. K. Owens, and M. A. Hlatky
Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery
Ann Intern Med,
November 20, 2007;
147(10):
703 - 716.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Bainbridge, D. Cheng, J. Martin, R. Novick, and The Evidence-based Peri-operative Clinical Outcome
Does off-pump or minimally invasive coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with percutaneous coronary intervention? A meta-analysis of randomized trials
J. Thorac. Cardiovasc. Surg.,
March 1, 2007;
133(3):
623 - 631.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. B. Barner
Status of percutaneous coronary intervention and coronary artery bypass.
Eur. J. Cardiothorac. Surg.,
September 1, 2006;
30(3):
419 - 424.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Thiele, S. Oettel, S. Jacobs, R. Hambrecht, P. Sick, J. F. Gummert, F. W. Mohr, G. Schuler, and V. Falk
Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery: A 5-Year Follow-Up
Circulation,
November 29, 2005;
112(22):
3445 - 3450.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Bonatti, T. Schachner, N. Bonaros, G. Laufer, C. Kolbitsch, J. Margreiter, P. Jonetzko, O. Pachinger, and G. Friedrich
Robotic Totally Endoscopic Coronary Artery Bypass and Catheter Based Coronary Intervention in One Operative Session
Ann. Thorac. Surg.,
June 1, 2005;
79(6):
2138 - 2141.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Fraund, G. Herrmann, A. Witzke, J. Hedderich, G. Lutter, M. Brandt, A. Boning, and J. Cremer
Midterm Follow-Up After Minimally Invasive Direct Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention Techniques
Ann. Thorac. Surg.,
April 1, 2005;
79(4):
1225 - 1231.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Sawhney, J. W. Moses, M. B. Leon, R. E. Kuntz, J. J. Popma, W. Bachinsky, T. Bass, S. DeMaio, E. Fry, D. R. Holmes Jr, et al.
Treatment of Left Anterior Descending Coronary Artery Disease With Sirolimus-Eluting Stents
Circulation,
July 27, 2004;
110(4):
374 - 379.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Drenth, N. J.G.M. Veeger, J. G. Grandjean, M. A. Mariani, A. J. van Boven, and P. W. Boonstra
Isolated high-grade lesion of the proximal LAD: a stent or off-pump LIMA?
Eur. J. Cardiothorac. Surg.,
April 1, 2004;
25(4):
567 - 571.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Verma, P. W.M. Fedak, R. D. Weisel, P. E. Szmitko, M. V. Badiwala, D. Bonneau, D. Latter, L. Errett, and Y. LeClerc
Off-Pump Coronary Artery Bypass Surgery: Fundamentals for the Clinical Cardiologist
Circulation,
March 16, 2004;
109(10):
1206 - 1211.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Mack, D. J. Drenth, F. Zijlstra, P. W. Boonstra, J. W. Moses, and M. B. Leon
Sirolimus-Eluting Coronary Stents
N. Engl. J. Med.,
January 22, 2004;
350(4):
413 - 414.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. L. Ngaage
Off-pump coronary artery bypass grafting: the myth, the logic and the science
Eur. J. Cardiothorac. Surg.,
October 1, 2003;
24(4):
557 - 570.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. W. LoGerfo, D. J. Drenth, N. J.G.M. Veeger, P. W. Boonstra, G. D'Ancona, H. Karamanoukian, R. E. Dragu, W. C. Wood, H. Thiele, F. W. Mohr, et al.
Minimally Invasive Bypass Surgery
N. Engl. J. Med.,
December 26, 2002;
347(26):
2165 - 2168.
[Full Text]
[PDF]
|
|
|
|
