title: Comparison of sirolimus-eluting stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 7-year follow-up of a randomized trial.
abstract: OBJECTIVE
  The aim of this analysis was to assess the 7-year long-term safety and effectiveness of a randomized comparison of percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery for the treatment of isolated proximal left anterior descending lesions.
  
  
  BACKGROUND
  Long-term follow-up data comparing PCI by SES and MIDCAB surgery for isolated proximal left anterior descending lesions are sparse.
  
  
  METHODS
  Patients were randomized either to PCI with SES (n = 65) or MIDCAB (n = 65). Follow-up data were obtained after 7 years with respect to the primary composite endpoint of death, myocardial infarction, and target vessel revascularization. Angina was assessed by the Canadian Cardiovascular Society classification and quality of life with Short Form 36 and MacNew quality of life questionnaires.
  
  
  RESULTS
  Follow-up was conducted in 129 patients at a median time of 7.3 years (interquartile range: 5.7, 8.3). There were no significant differences in the incidence of the primary composite endpoint between groups (22% PCI vs. 12% MIDCAB; p = 0.17) or the endpoints death (14% vs. 17%; p = 0.81) and myocardial infarction (6% vs. 9%, p = 0.74). However, the target vessel revascularization rate was higher in the PCI group (20% vs. 1.5%; p < 0.001). Clinical symptoms and quality of life improved significantly from baseline with both interventions and were similar in magnitude between groups.
  
  
  CONCLUSIONS
  At 7-year follow-up, PCI by SES and MIDCAB in isolated proximal left anterior descending lesions yielded similar long-term outcomes regarding the primary composite clinical endpoint and quality of life. Target vessel revascularization was more frequent in the PCI group. (MIDCAB Versus DES in Proximal LAD Lesions; NCT00299429).
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Blazek
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Rossbach
authors.affiliation: Department of Cardiac Surgery, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany; Medical Clinic II, University of Lübeck, Lübeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany; Medical Clinic II, University of Lübeck, Lübeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stiermaier
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.affiliation: Department of Cardiac Surgery, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Holzhey
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Department of Cardiac Surgery, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany; Medical Clinic II, University of Lübeck, Lübeck, Germany. Electronic address: holger.thiele@uksh.de.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D053208:Kaplan-Meier Estimate; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011474:Prosthesis Design; D011788:Quality of Life; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D020123:Sirolimus
keywords: bypass surgery; drug-eluting stent; left anterior descending artery; long-term follow-up; percutaneous coronary intervention