Comparison of bare-metal stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 10-year follow-up of a randomized trial.
OBJECTIVE
The aim of this prospective, randomized trial was to assess the 10-year long-term safety and effectiveness of percutaneous coronary intervention (PCI) and minimally invasive direct coronary artery bypass surgery (MIDCAB) for the treatment of proximal left anterior descending (LAD) lesions.


BACKGROUND
Long-term follow-up data comparing PCI and MIDCAB surgery for isolated proximal LAD lesions are sparse.


METHODS
Patients with significant isolated proximal LAD stenoses were randomized either to PCI with bare-metal stents (n = 110) or MIDCAB (n = 110). At 10 years, data were obtained with respect to the primary endpoint (death, myocardial infarction, target vessel revascularization). Angina was assessed by the Canadian Cardiovascular Society classification.


RESULTS
Follow-up was conducted for 212 patients at a median time of 10.3 years. There were no significant differences in the binary primary composite endpoint (47% vs. 36%; p = 0.12) and hard endpoints (death and infarction) between PCI and MIDCAB. However, a higher target vessel revascularization rate in the PCI group (34% vs. 11%; p < 0.01) was observed. Clinical symptoms improved significantly from baseline and were similar between both treatment groups.


CONCLUSIONS
At 10-year follow-up, PCI and MIDCAB in isolated proximal LAD lesions yielded similar long-term outcomes regarding the primary composite clinical endpoint. Target vessel revascularization was more frequent in the PCI group.
Department of Internal Medicine, Cardiology, University of Leipzig-Heart Center, Strümpellstrasse 39, Leipzig, Germany.
Stephan
S
Blazek
David
D
Holzhey
Camelia
C
Jungert
Michael A
MA
Borger
Georg
G
Fuernau
Steffen
S
Desch
Ingo
I
Eitel
Suzanne
S
de Waha
Philipp
P
Lurz
Gerhard
G
Schuler
Friedrich-Wilhelm
FW
Mohr
Holger
H
Thiele
D000787:Angina Pectoris / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D023921:Coronary Stenosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D018572:Disease-Free Survival; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008670:Metals; D019060:Minimally Invasive Surgical Procedures; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals