Treatment of left anterior descending coronary artery stenosis: stent or surgery
Mesut Sismanoglu1, Sabit Sarikaya, Oruc Alper Onk
1Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Insights
Drug-eluting stents and off-pump coronary bypass showed no significant 5-year outcome differences for left anterior descending lesions. Patient-specific factors should guide treatment decisions for successful long-term results.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Drug-eluting stents (DES) offer a solution to restenosis post-bare-metal stent implantation.
- DES are considered an alternative to off-pump coronary bypass (OPCAB) for specific coronary artery lesions.
- Long-term efficacy of DES versus OPCAB requires further definition.
Purpose of the Study:
- To compare the 5-year angiographic and clinical outcomes of DES versus OPCAB.
- To evaluate the long-term effectiveness and safety of these revascularization strategies.
Main Methods:
- A prospective study involving 64 patients from January to December 2004.
- 31 patients received DES, and 33 underwent OPCAB for isolated left anterior descending lesions.
- Primary endpoint: angiographic outcome; Secondary endpoint: clinical outcome at 5 years.
Main Results:
- No early or late mortality observed in either group.
- Significantly shorter hospital stay for the DES group (2.5 days vs. 7.1 days, p=0.003).
- OPCAB group showed higher long-term patency and fewer major adverse cardiac events, though not statistically significant.
Conclusions:
- Five-year follow-up revealed no significant difference in primary or secondary endpoints between DES and OPCAB.
- Lack of significant difference necessitates collaborative, individualized treatment decisions by cardiologists and surgeons.
- Achieving successful long-term outcomes depends on a tailored approach for each patient.
Background:
Drug-eluting stents have emerged as a solution to the problem of restenosis after bare-metal stent implantation, as an alternative to off-pump coronary bypass, for isolated left anterior descending coronary artery lesions at short-term follow-up. However, long-term follow-up is yet to be defined.
Methods:
From January to December 2004, 64 consecutive patients underwent myocardial revascularization: 31 by drug-eluting stents and 33 by off-pump coronary bypass. The primary endpoint was angiographic outcome, and the secondary endpoint was clinical outcome at 5 years.
Results:
There was no early or late mortality in either group. Hospital stay was significantly shorter in the stent group (2.5 ± 2.1 vs. 7.1 ± 4.9 days, p = 0.003). Long-term patency was higher and major adverse cardiac events (recurrence of angina and revascularization of target vessel) were encountered less frequently in the coronary bypass group, although not significantly.
Conclusion:
The 5-year follow-up showed no significant difference between the off-pump coronary bypass and stent groups for the primary and secondary endpoints. As a significant difference between treatment options is lacking, decision-making for appropriate treatment in this group of patients requires the collaboration of cardiologists and cardiovascular surgeons and an individual approach, to achieve successful long-term outcomes.
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