Isolated Left Anterior Descending Coronary Artery Disease : Percutaneous Transluminal Coronary Angioplasty Versus Stenting Versus Left Internal Mammary Artery Bypass Grafting

Abstract

Background-Single-vessel coronary artery disease is usually treated with PTCA; however, this approach when applied to the left anterior descending coronary artery (LAD) is hampered by high restenosis rates, often approaching 50%. Coronary stenting (STENT) and left internal mammary artery bypass grafting of the LAD (LIMA-LAD) are other options that have been successfully used for single-vessel LAD disease. The optimal mode of revascularization for patients with isolated single-vessel LAD disease is unclear. The purpose of the present study was to examine PTCA versus STENT versus LIMA-LAD with respect to short-and intermediate-term outcomes. Methods and Results-This was an observational retrospective cohort study comparing in-hospital and intermediate-term outcomes and functional class among patients with isolated single-vessel LAD disease revascularization. Consecutive eligible patients were grouped according to their initial revascularization procedure and systematically followed up. A total of 704 patients qualified for the study: 469 in the PTCA group, 137 in the STENT group, and 98 in the LIMA-LAD group. Follow-up data were complete for 97% of patients and averaged 27Ϯ13 months. In-hospital mortality for the PTCA, STENT, and LIMA-LAD groups was 1.1%, 0%, and 0% (Pϭ0.51), respectively. Median hospital stays after the procedure for the respective treatment groups were 1, 1, and 5 days (PϽ0.001), and occurrences of in-hospital myocardial infarction were 0.9%, 1.5%, and 1.0% (PϭNS). Repeat revascularization procedures were performed in 30%, 24%, and 5% of the PTCA, STENT, and LIMA-LAD groups (PϭϽ0.001 for LIMA-LAD versus other groups, Pϭ0.11 for PTCA versus STENT). Actuarial 2-year mortality was 3.9%, 2.6%, and 1% in the PTCA, STENT, and LIMA-LAD groups (Pϭ0.33). Conclusions-Revascularization for isolated LAD disease using PTCA, STENT, or LIMA-LAD results in low in-hospital adverse event rates and good long-term results. Repeat procedures are required less often after LIMA-LAD than after either PTCA or STENT. Long-term mortality was not statistically different, but the trend was for the lowest mortality with LIMA-LAD, a somewhat higher mortality with STENT, and the highest mortality with PTCA. (Circulation. 1999;100[suppl II]:II-114-II-118.) Key Words: angioplasty Ⅲ stents Ⅲ grafting Ⅲ coronary disease Ⅲ bypass Ⅲ revascularization T he left anterior descending coronary artery (LAD) is almost always the largest of the 3 epicardial coronary arteries. The LAD typically subtends Ϸ50% of the left ventricular myocardial mass, or approximately twice as much as either the right or the left circumflex coronary arteries. 1,2 Patients with significant LAD disease, particularly when the proximal vessel is involved, have been noted to have an adverse cardiac prognosis compared with patients with coronary artery disease that does not involve the LAD. 3-5 Although PTCA, coronary stenting (STENT), and left internal mammary artery bypass grafting (LIMA-LAD) are all used frequently for this high-risk lesion, the optimal approach re...

Treatment of Left Anterior Descending Coronary Artery Disease With Sirolimus-Eluting Stents

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Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

“…1,2 Minimally invasive direct coronary artery bypass surgery and percutaneous coronary intervention with bare-metal stents are established treatment options that effectively relieve symptoms. 3,4 In randomized trials comparing the 2 strategies, a significantly higher reintervention rate after stenting and similar results for mortality and reinfarction at a 6-month follow-up have been demonstrated. 4 -6 Because the high initial success rate is eroded over time by clinical events, the long-term follow-up is more appropriate to elucidate the merits of surgery or the interventional procedure.…”

Stents farmacológicos versus não-farmacológicos para o tratamento de pacientes uniarteriais portadores de lesão em artéria descendente anterior: seguimento clínico de dois anos

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