title: Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery: six months' angiographic and clinical follow-up of a prospective randomized study.
abstract: OBJECTIVE
  We sought to compare minimally invasive coronary artery bypass grafting (surgical intervention) with percutaneous transluminal coronary angioplasty with primary stenting (stenting) in patients having an isolated high-grade stenosis (American College of Cardiology/American Heart Association classification type B2 or C) of the proximal left anterior descending coronary artery. At 6 months, both procedures were compared on the basis of quantitative angiography and clinical outcome.
  
  
  METHODS
  Both treatments were compared in a single-center, prospective, randomized study. The primary end point of this study was quantitative angiographic outcome at 6 months. The secondary end point was 6-month clinical outcome. Statistical analysis was performed in accordance with the intention-to-treat principle.
  
  
  RESULTS
  From March 1997 to September 1999, patients with angina pectoris caused by an isolated high-grade stenosis of the proximal left anterior descending coronary artery were randomly assigned to surgical intervention (n = 51) or stenting (n = 51). At 6 months, quantitative coronary angiography showed an anastomotic stenosis rate of 4% after surgical intervention and a restenosis rate of 29% after stenting (P <.001). Periprocedural events did not significantly differ between surgical intervention and stenting. After surgical intervention, 2 patients died; no patients died after stenting. After 6 months, no significant difference was found for major adverse cardiac or cerebral events and need for repeat target vessel revascularization. After 6 months, return of angina pectoris, physical work capacity, and use of antianginal drugs did not significantly differ between treatments.
  
  
  CONCLUSIONS
  After 6 months, surgical intervention had a significantly better angiographic outcome than stenting in patients with an isolated high-grade stenosis of the proximal left anterior descending coronary artery. Clinical outcome did not significantly differ between treatments.
authors.affiliation: Thoraxcentre of the Groningen University Hospital, Groningen, The Netherlands.
authors.forename: Derk J
authors.initials: DJ
authors.lastname: Drenth
authors.forename: Jobst B
authors.initials: JB
authors.lastname: Winter
authors.forename: Nic J G M
authors.initials: NJ
authors.lastname: Veeger
authors.forename: Stefan H J
authors.initials: SH
authors.lastname: Monnink
authors.forename: Ad J
authors.initials: AJ
authors.lastname: van Boven
authors.forename: Jan G
authors.initials: JG
authors.lastname: Grandjean
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Mariani
authors.forename: Piet W
authors.initials: PW
authors.lastname: Boonstra
mesh_terms: D000787:Angina Pectoris / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D015607:Stents; D013997:Time Factors