title: A prospective randomized trial comparing stenting to internal mammary artery grafting for proximal, isolated de novo left anterior coronary artery stenosis: the SIMA trial. Stenting vs Internal Mammary Artery.
abstract: OBJECTIVE
  To compare coronary artery bypass grafting (CABG) with percutaneous transluminal coronary angioplasty (PTCA) in patients with proximal, isolated de novo left anterior descending coronary artery disease and left ventricular ejection fraction of 45%.
  
  
  METHODS
  In the multicenter Stenting vs Internal Mammary Artery (SIMA) study, patients were randomly assigned to PTCA and stent implantation or to CABG (using the internal mammary artery). The primary clinical composite end point was event-free survival, including death, myocardial infarction, and the need for additional revascularization. Secondary end points were functional class, antianginal treatment, and quality of life. Analyses were by intention to treat.
  
  
  RESULTS
  Of 123 patients who accepted randomization, 59 underwent CABG, and 62 were treated with stent implantation (2 patients were excluded because of protocol violation). At a mean +/- SD follow-up of 2.4+/-0.9 years, a primary end point had occurred in 19 patients (31%) in the stent group and in 4 (7%) in the CABG group (P<.001). This significant difference in clinical outcome is due to a higher incidence of additional revascularization in the stent group, the incidence of death and myocardial infarction being similar (7% vs 7%, respectively; P=.90). The functional class, need for antianginal drug, and quality-of-life assessment showed no significant differences.
  
  
  CONCLUSIONS
  Both stent implantation and CABG are safe and highly effective treatments to relieve symptoms in patients with isolated, proximal left anterior descending coronary artery stenosis. Both are associated with a low and comparable incidence of death and myocardial infarction. However, similar to PTCA alone, a percutaneous approach using elective stent placement remains hampered by a higher need for repeated intervention because of restenosis.
authors.affiliation: Division of Cardiology, University Hospital Lausanne, Switzerland. jjgoy@hotmail.com
authors.forename: J J
authors.initials: JJ
authors.lastname: Goy
authors.forename: U
authors.initials: U
authors.lastname: Kaufmann
authors.forename: D
authors.initials: D
authors.lastname: Goy-Eggenberger
authors.forename: A
authors.initials: A
authors.lastname: Garachemani
authors.forename: M
authors.initials: M
authors.lastname: Hurni
authors.forename: T
authors.initials: T
authors.lastname: Carrel
authors.forename: A
authors.initials: A
authors.lastname: Gaspardone
authors.forename: B
authors.initials: B
authors.lastname: Burnand
authors.forename: B
authors.initials: B
authors.lastname: Meier
authors.forename: F
authors.initials: F
authors.lastname: Versaci
authors.forename: F
authors.initials: F
authors.lastname: Tomai
authors.forename: O
authors.initials: O
authors.lastname: Bertel
authors.forename: M
authors.initials: M
authors.lastname: Pieper
authors.forename: M
authors.initials: M
authors.lastname: de Benedictis
authors.forename: E
authors.initials: E
authors.lastname: Eeckhout
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome