title: Directional coronary atherectomy plus stent implantation vs. left internal mammary artery bypass grafting for isolated proximal stenosis of the left anterior descending coronary artery.
abstract: The aim of this study was to compare the short- (< 30 days) and long-term (> or = 30 days) clinical outcomes of left internal mammary artery bypass grafting (LIMA-LAD) and directional coronary atherectomy plus stent implantation (DCA + stent) in the treatment of isolated proximal left anterior descending coronary (LAD) lesions. One hundred and twenty-six patients underwent LIMA-LAD and 132 consecutive patients underwent DCA + stenting. The primary endpoint was the incidence of short- and long-term major adverse cardiac events (MACE); the secondary endpoints included any periprocedural events and long-term target vessel revascularization (TVR). We found no significant between-treatment difference in the occurrence of short-term MACE, and the long-term MACE rate per 100 person-years was 3.0 in the LIMA-LAD group and 4.6 in the DCA + stent group. After 5-year follow-up, 79% of the patients in the DCA + stent group and 89% of those in the LIMA-LAD group were still MACE-free. The risk of any periprocedural events was six times lower in the DCA + stent group, and the risk of TVR was six times higher. We conclude that both procedures lead to good short- and long-term follow-up results in isolated proximal LAD disease. As fewer periprocedural events and more TVRs occur after DCA + stenting than after LIMA-LAD, they can be considered valuable alternatives to each other.
authors.affiliation: Division of Cardiology, IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.forename: Alessandra
authors.initials: A
authors.lastname: Repetto
authors.forename: Ezio
authors.initials: E
authors.lastname: Bramucci
authors.forename: Umberto
authors.initials: U
authors.lastname: Canosi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferrario
authors.forename: Luigi
authors.initials: L
authors.lastname: Angoli
authors.forename: Marco
authors.initials: M
authors.lastname: Aiello
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Mario
authors.initials: M
authors.lastname: Viganò
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000628:therapy; D017225:Atherectomy, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D023921:Coronary Stenosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome