Revascularization of the left anterior descending artery with drug-eluting stents: comparison with arterial off-pump surgery.
BACKGROUND
This study compared early results of left anterior descending artery (LAD) stenting using drug-eluting stents (Cypher) with off-pump bilateral internal thoracic arterial (BITA) grafting.


METHODS
From June 2002 to June 2003, 200 consecutive patients underwent myocardial revascularization of the LAD territory, 100 by Cypher and 100 by BITA. The 2 groups were similar; however, left main disease and triple-vessel disease (20% and 75% versus 2% and 28%), age >70 (36% versus 17%) and intraaortic balloon pump (7% versus 0%) were more prevalent in the BITA group, and prior percutaneous coronary angiogplasty to the LAD was more prevalent in the Cypher group (28% versus 16%).


RESULTS
The number of coronary vessels treated per patient in the BITA group was higher (2.7 versus 1.45, P < .01). Thirty-day mortality was 1% in the BITA group and 0% in the Cypher group. Mean follow-up was 12 months. There was 1 late death in each group. Angina returned in 32% of the Cypher group and in 1% of the BITA group. There were 9 reinterventions in the Cypher group: 7 coronary angioplasties (including 2 to the LAD) and 2 surgical interventions. There was neither recurrent angina nor reintervention in the surgical group.


CONCLUSIONS
Despite a higher risk profile of patients treated with BITA, their clinical outcome is better. A longer and more complete angiographic follow-up is required to determine the role of drug-eluting stents in LAD revascularization.
Herz
Itzhak
I
Department of Cardiology, The Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Israel. isach@tasmc.health.gov.il
Mohr
Rephael
R
Moshkovitz
Yaron
Y
Ben-Gal
Yanai
Y
Adam
Sharon Z
SZ
Braunstein
Roni
R
Uretzky
Gideon
G
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001807:Blood Vessel Prosthesis; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000601:surgery*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D015607:Stents; D016896:Treatment Outcome
D000925:Anticoagulants