Coronary angioplasty versus left internal mammary artery grafting for isolated proximal left anterior descending artery stenosis.

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State: Public
Version: author
Serval ID
serval:BIB_E4163075DF80
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Coronary angioplasty versus left internal mammary artery grafting for isolated proximal left anterior descending artery stenosis.
Journal
Lancet
Author(s)
Goy J.J., Eeckhout E., Burnand B., Vogt P., Stauffer J.C., Hurni M., Stumpe F., Ruchat P., Sadeghi H., Kappenberger L.
ISSN
0140-6736 (Print)
ISSN-L
0140-6736
Publication state
Published
Issued date
06/1994
Peer-reviewed
Oui
Volume
343
Number
8911
Pages
1449-1453
Language
english
Abstract
Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are more effective than medical treatment for the management of ischaemic heart disease. However, patients with single-vessel involvement have been excluded from prospective comparisons of the two methods. We have carried out such a comparison in patients with isolated proximal left anterior descending artery stenosis, conserved left ventricular function, and documented ischaemia. Eligible patients presenting to a single centre were randomly assigned PTCA (68 patients) or left internal mammary grafting (66). The procedures were technically feasible in all cases. The incidence of in-hospital complications was 2% (perioperative myocardial infarction) for CABG and 3% (emergency CABG for acute closure) for PTCA. Clinical and functional status improved similarly in both groups. However, patients in the PTCA group took more antianginal drugs. At median follow-up of 2.5 years, 86% of CABG-treated and 43% of PTCA-treated patients were free from adverse events (p < 0.01; relative risk 2.0 [95% CI 1.7-2.3]). The adverse events that explain this difference were restenosis (32%) requiring subsequent surgical (16%) or percutaneous (15%) revascularisation (1% had medical therapy). Rates of cardiac death and myocardial infarction did not differ between the groups. Both CABG and PTCA improve the clinical status of symptomatic patients with single-vessel coronary artery disease. If patient and physician accept the risk of restenosis and reintervention associated with PTCA, this procedure remains a suitable option and a simpler initial alternative to CABG.
Keywords
Angioplasty, Balloon, Coronary, Coronary Angiography, Coronary Artery Bypass, Exercise Test, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction/diagnosis, Myocardial Infarction/etiology, Myocardial Ischemia/complications, Myocardial Ischemia/radiography, Prospective Studies, Recurrence, Treatment Outcome
Pubmed
Web of science
Create date
28/01/2008 9:52
Last modification date
20/08/2019 16:07
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