Background: We have previously shown at 2 years, that both PTCA and
CABG improve the clinical status of patients (pts) with isolated proximal LAD
stenosis without differences in the incidence of death or MI. Only additional
revascularisation was more frequently required after PTCA.
Methode: The 134 pts randomised to CABG (n = 66) or PTCA (n = 68) were
followed up to 5 years. The end-points were: death, incidence of MI, need for
additional revascularisation, clinical status and medical treatment. Analysis are
made based on the intention to treat principle.
Results: At 5 years, death occurred in 1 patient (1%) in the CABG group
versus 6 patients (8%) pts after PTCA. However only one pt (1%), only, in
each group died from a cardiac cause. MI was significantly more frequent in
the PTCA group 15% versus 4% (p < 0.05) but Q wave MI not, PTCA 6%,
CABG 3% (N.S.). Most of the MI were related to acute closure or restenosis
with only CK rise. Additional revascularisation was required in 36% of patients
after PTCA versus 9% in the CABG group (p < 0.05). LAD revascularisation
was more frequent 26% versus 4.5%. Interestingly non in the PTCA group.
Surprinsingly non-LAD revascularisation was also more frequent in the PTCA
group 12% versus 4.5%. Clinical status was similar with only 3% (CABG) and
6% (PTCA) in CCS class III or IV. There was no difference in the medical
treatment. Mean cholesterol blood value was 5.9 in both group. Finally 91%
after CABG and 62% after PTCA were free of any events (p < 0.05).
Conclusion: The 5 year prognosis of pts with isolated proximal LAD stenosis
is very good. Both PTCA and CABG improve the clinical status but more
additional revascularisation after PTCA was needed. There is an excess
incidence of non Q wave MI in the PTCA group which does not affect the
vitai or symptomatic outcome.