title: Five-year outcome in patients with isolated proximal left anterior descending coronary artery stenosis treated by angioplasty or left internal mammary artery grafting. A prospective trial.
abstract: BACKGROUND
  Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) improve the clinical status of patients with isolated proximal left anterior descending coronary artery stenosis. At 2 years, only additional revascularization was more frequently required after PTCA.
  
  
  RESULTS
  We monitored 134 patients randomized to PTCA (n=68) or CABG (n=66) for </=5 years. End points were death, myocardial infarction, need for additional revascularization, clinical status, and medical treatment. At 5 years, 6 patients (9%) had died in the PTCA group versus 2 (3%) in the CABG group (P=0.12). One patient in each group died of a cardiac cause. Myocardial infarction was more frequent after PTCA (15% versus 4%; P=0.0001), but Q-wave infarction was not (6% in the PTCA group versus 3% in the CABG group; P=0.8). Additional revascularization was required in 38% of patients in the PTCA group versus 9% in the CABG group (P=0.0001). Functional status was comparable, with 6% of patients after PTCA and 3% after CABG in functional class III or IV. Finally, after PTCA or CABG, 62% and 91% of patients, respectively, were free of events (P=0.0001).
  
  
  CONCLUSIONS
  The 5-year prognosis of patients with isolated proximal left anterior descending coronary artery stenosis is good. Both PTCA and CABG improve clinical status, but revascularization was needed more frequently after PTCA. There is an excess incidence of non-Q-wave myocardial infarction in the PTCA group that does not affect the vital or symptomatic outcome.
authors.affiliation: Division of Cardiology, Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. jean-jacques.goy@chuv.hospvd.ch
authors.forename: J J
authors.initials: JJ
authors.lastname: Goy
authors.forename: E
authors.initials: E
authors.lastname: Eeckhout
authors.forename: C
authors.initials: C
authors.lastname: Moret
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: L
authors.initials: L
authors.lastname: von Segesser
authors.forename: P
authors.initials: P
authors.lastname: Urban
authors.forename: L
authors.initials: L
authors.lastname: Kappenberger
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome