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CLINICAL RESEARCH: CLINICAL TRIAL

10-Year Follow-Up of a Prospective Randomized Trial Comparing Bare-Metal Stenting With Internal Mammary Artery Grafting for Proximal, Isolated De Novo Left Anterior Coronary Artery Stenosis

The SIMA (Stenting versus Internal Mammary Artery grafting) Trial

Jean-Jacques Goy, MD, FESC^_*,_*, Urs Kaufmann, MD, FESC, Michel Hurni, MD^_*, Stéphane Cook, MD, Francesco Versaci, MD, Patrick Ruchat, MD^_*, Osmund Bertel, MD, FESC, FACC, Michael Pieper, MD^||, Bernhard Meier, MD, FESC, FACC, Luigi Chiarello, MD, Eric Eeckhout, MD, FESC, PhD^_* for the SIMA Investigators

^_* Service de Cardiologie, University Hospital, Lausanne, Switzerland
Kardiologie Abteilung, University Hospital, Bern, Switzerland
Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
HerzGefässZentrum, Zürich, Switzerland
^|| Herzzentrum Bodensee, Kreuzlingen, Switzerland

Manuscript received November 26, 2007; revised manuscript received May 20, 2008, accepted May 27, 2008.

^_* Reprint requests and correspondence: Dr. Jean-Jacques Goy, Clinique Cecil, Avenue Ruchonnet 33, 1003 Lausanne, Switzerland (Email: jjgoy{at}goyman.com).

Objectives: This study was designed to compare the long-term clinical outcome of coronary artery bypass grafting (CABG) with intracoronary stenting of patients with isolated proximal left anterior descending coronary artery.

Background: Although numerous trials have compared coronary angioplasty with bypass surgery, none assessed the clinical evaluation in the long term.

Methods: We evaluated the 10-year clinical outcome in the SIMA (Stent versus Internal Mammary Artery grafting) trial. Patients were randomly assigned to stent implantation versus CABG.

Results: Of 123 randomized patients, 59 underwent CABG and 62 received a stent (2 patients were excluded). Follow-up after 10 years was obtained for 98% of the randomized patients. Twenty-six patients (42%) in the percutaneous coronary intervention group and 10 patients (17%) in the CABG group reached an end point (p < 0.001). This difference was due to a higher need for additional revascularization. The incidences of death and myocardial infarction were identical at 10%. Progression of the disease requiring additional revascularization was rare (5%) and was similar for the 2 groups. Stent thrombosis occurred in 2 patients (3%). Angina functional class showed no significant differences between the 2 groups.

Conclusions: Both stent implantation and CABG are safe and highly effective in relieving symptoms in patients with isolated, proximal left anterior descending coronary artery stenosis. Stenting with bare-metal stents is associated with a higher need for repeat interventions. The long-term prognosis for these patients is excellent with either mode of revascularization.

Key Words: CABG • stenting • proximal LAD stenosis

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   LAD = left anterior descending   PCI = percutaneous coronary intervention

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