Isolated high-grade lesion of the proximal LAD: a stent or off-pump LIMA?

Objectives: The objective of this study was to compare the long-term outcome of patients with an isolated high-grade stenosis of the left anterior descending (LAD) coronary artery randomized to percutaneous transluminal coronary angioplasty with stenting (PCL stenting) or to off-pump coronary artery bypass grafting (surgery). Methods: Patients with an isolated high-grade stenosis (American College of Cardiology/American Heart Association classification type B2/C) of the proximal LAD were randomly assigned to stenting (n = 51) or to surgery (n = 5 1) and were followed for 3-5 years (mean 4 years). Primary composite endpoint was freedom from major adverse cardiac and cerebrovascular events (MACCEs), including cardiac death, myocardial infarction, stroke and repeat target vessel revascularization. Secondary endpoints were angina pectoris status and need for anti-anginal medication at follow-up. Analysis was by intention to treat. Results: MACCEs occurred in 27.5% after stenting and 9.8% after surgery (P = 0.02; absolute risk reduction 17.7%). Freedom from angina pectoris was 67% after stenting and 85% after surgery (P = 0.036). Need for anti-anginal medication was significantly lower after surgery compared to stenting (P = 0.002). Conclusion: Patients with an isolated high-grade lesion of the proximal LAD have a significantly better 4-year clinical outcome after off-pump coronary bypass grafting than after PCI. (C) 2004 Elsevier B.V. All rights reserved.