title: Coronary angioplasty versus left internal mammary artery grafting for isolated proximal left anterior descending artery stenosis.
abstract: Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are more effective than medical treatment for the management of ischaemic heart disease. However, patients with single-vessel involvement have been excluded from prospective comparisons of the two methods. We have carried out such a comparison in patients with isolated proximal left anterior descending artery stenosis, conserved left ventricular function, and documented ischaemia. Eligible patients presenting to a single centre were randomly assigned PTCA (68 patients) or left internal mammary grafting (66). The procedures were technically feasible in all cases. The incidence of in-hospital complications was 2% (perioperative myocardial infarction) for CABG and 3% (emergency CABG for acute closure) for PTCA. Clinical and functional status improved similarly in both groups. However, patients in the PTCA group took more antianginal drugs. At median follow-up of 2.5 years, 86% of CABG-treated and 43% of PTCA-treated patients were free from adverse events (p < 0.01; relative risk 2.0 [95% CI 1.7-2.3]). The adverse events that explain this difference were restenosis (32%) requiring subsequent surgical (16%) or percutaneous (15%) revascularisation (1% had medical therapy). Rates of cardiac death and myocardial infarction did not differ between the groups. Both CABG and PTCA improve the clinical status of symptomatic patients with single-vessel coronary artery disease. If patient and physician accept the risk of restenosis and reintervention associated with PTCA, this procedure remains a suitable option and a simpler initial alternative to CABG.
authors.affiliation: Divison of Cardiology, Centre Hospitaller Universitaire Vaudols, Lausanne, Switzerland.
authors.forename: J J
authors.initials: JJ
authors.lastname: Goy
authors.forename: E
authors.initials: E
authors.lastname: Eeckhout
authors.forename: B
authors.initials: B
authors.lastname: Burnand
authors.forename: P
authors.initials: P
authors.lastname: Vogt
authors.forename: J C
authors.initials: JC
authors.lastname: Stauffer
authors.forename: M
authors.initials: M
authors.lastname: Hurni
authors.forename: F
authors.initials: F
authors.lastname: Stumpe
authors.forename: P
authors.initials: P
authors.lastname: Ruchat
authors.forename: H
authors.initials: H
authors.lastname: Sadeghi
authors.forename: L
authors.initials: L
authors.lastname: Kappenberger
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome