title: Treatment of left anterior descending coronary artery stenosis: stent or surgery.
abstract: BACKGROUND
  Drug-eluting stents have emerged as a solution to the problem of restenosis after bare-metal stent implantation, as an alternative to off-pump coronary bypass, for isolated left anterior descending coronary artery lesions at short-term follow-up. However, long-term follow-up is yet to be defined.
  
  
  METHODS
  From January to December 2004, 64 consecutive patients underwent myocardial revascularization: 31 by drug-eluting stents and 33 by off-pump coronary bypass. The primary endpoint was angiographic outcome, and the secondary endpoint was clinical outcome at 5 years.
  
  
  RESULTS
  There was no early or late mortality in either group. Hospital stay was significantly shorter in the stent group (2.5 ± 2.1 vs. 7.1 ± 4.9 days, p = 0.003). Long-term patency was higher and major adverse cardiac events (recurrence of angina and revascularization of target vessel) were encountered less frequently in the coronary bypass group, although not significantly.
  
  
  CONCLUSIONS
  The 5-year follow-up showed no significant difference between the off-pump coronary bypass and stent groups for the primary and secondary endpoints. As a significant difference between treatment options is lacking, decision-making for appropriate treatment in this group of patients requires the collaboration of cardiologists and cardiovascular surgeons and an individual approach, to achieve successful long-term outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Mesut
authors.initials: M
authors.lastname: Sismanoglu
authors.forename: Sabit
authors.initials: S
authors.lastname: Sarikaya
authors.forename: Oruc Alper
authors.initials: OA
authors.lastname: Onk
authors.forename: Taylan
authors.initials: T
authors.lastname: Adademir
authors.forename: Eray
authors.initials: E
authors.lastname: Aksoy
authors.forename: Kaan
authors.initials: K
authors.lastname: Kirali
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000503:physiopathology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Coronary artery bypass; coronary artery disease; drug-eluting stents; heart catheterization; off-pump; treatment outcome