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Isolated high-grade lesion of the proximal LAD: a stent or off-pump LIMA?
Derk J Drenth1, Nic J G M Veeger, Jan G Grandjean
1Thoraxcentre, Groningen University Hospital, Groningen, The Netherlands.
Insights
Off-pump coronary artery bypass grafting (surgery) offers superior long-term outcomes compared to percutaneous transluminal coronary angioplasty with stenting (PCI) for isolated high-grade left anterior descending stenosis. Surgery resulted in fewer major adverse cardiac events and better angina control.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- High-grade stenosis in the left anterior descending (LAD) coronary artery poses significant risks.
- Treatment decisions involve balancing risks and benefits of revascularization strategies.
- Off-pump coronary artery bypass grafting (surgery) and percutaneous transluminal coronary angioplasty with stenting (PCI) are primary interventions.
Purpose of the Study:
- To compare the long-term clinical outcomes of off-pump coronary artery bypass grafting versus PCI in patients with isolated high-grade LAD stenosis.
- To evaluate major adverse cardiac and cerebrovascular events (MACCEs) and symptom relief.
Main Methods:
- Randomized trial involving 102 patients with isolated high-grade LAD stenosis (type B2/C).
- Patients were assigned to either PCI (n=51) or off-pump surgery (n=51).
- Follow-up was conducted for 3-5 years, assessing MACCEs, angina status, and medication use.
Main Results:
- Off-pump surgery demonstrated a significantly lower incidence of MACCEs (9.8%) compared to PCI (27.5%).
- Patients undergoing surgery reported better freedom from angina pectoris (85%) versus PCI (67%).
- The need for anti-anginal medication was significantly lower following surgery.
Conclusions:
- Off-pump coronary artery bypass grafting provides superior long-term clinical outcomes for isolated high-grade LAD stenosis compared to PCI.
- Surgery leads to better symptom management and reduced major adverse events in this patient group.
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 (PCI, 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=51) 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.
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