A comparison of coronary artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery: five year clinical follow up.
BACKGROUND
Stent implantation for isolated stenosis of the proximal left anterior descending coronary artery (LAD) with preserved left ventricular function has been found to have a better clinical and angiographic outcome at one year than balloon angioplasty (PTCA).


OBJECTIVE
To establish whether those results are maintained at five year follow up.


METHODS
Patients were followed at least every six months. For those who died during follow up, data were obtained from medical records.


METHODS
Freedom from death, non-fatal myocardial infarction, cerebrovascular accident, and repeated target lesion revascularisation. Secondary end points were revascularisation in a remote region and freedom from angina.


RESULTS
Follow up was complete in all patients. At five years, the primary end point was reached more often by patients randomised to stent implantation than to PTCA (80% v 53%; odds ratio (OR) 0.29 (95% confidence interval (CI) 0.13 to 0.69); p = 0.0034). In the PTCA group, 35% of patients underwent target lesion revascularisation v 15% in the stent group (OR 0.33, 95% CI 0.13 to 0.80; p = 0.014). There was a trend towards increased mortality in the PTCA group than in the stent group (17% v 7%; OR 0.36, 95% CI 0.10 to 1.21; p = 0.098). No significant differences were found between PTCA and stent groups for non-fatal myocardial infarction (8% v 5%; OR 0.58, 95% CI 0.13 to 2.54; p = 0.46) or cerebrovascular accident (2% v 0%).


CONCLUSIONS
In patients with isolated stenosis of the proximal LAD, a five year clinical follow up confirmed a better outcome in those treated with stenting than with PTCA.
Versaci
F
F
Division of Cardiac Surgery, Università Tor Vergata, Rome, Italy. francescoversaci@yahoo.it
Gaspardone
A
A
Tomai
F
F
Proietti
I
I
Ghini
A S
AS
Altamura
L
L
Andò
G
G
Crea
F
F
Gioffrè
P A
PA
Chiariello
L
L
D000208:Acute Disease; D000787:Angina Pectoris / Q000150:complications / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D017202:Myocardial Ischemia / Q000150:complications / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods; D015607:Stents; D016896:Treatment Outcome
D002317:Cardiovascular Agents