Stenting Versus Internal Mammary Artery Grafting: 10-Year Follow-Up - SIMA: 10-Year Follow-Up

Description:

The goal of the trial was to evaluate stenting versus internal mammary artery (IMA) grafting for patients with isolated disease of the proximal left anterior descending (LAD) artery.

Hypothesis:

IMA grafting of a proximal LAD artery will be superior to bare-metal stenting.

Study Design

  • Randomized

Patients Screened: 123
Patients Enrolled: 121
Mean Follow Up: 10 years

Patient Populations:

  • Isolated proximal LAD coronary stenosis
  • Proximal LAD reference diameter >3 mm
  • Left ventricular function ≥45%

Primary Endpoints:

  • Death, MI, or urgent revascularization
  • Major in-hospital complications (MI and need for revascularization), angina class, and drug treatment

Drug/Procedures Used:

Patients with an isolated proximal LAD stenosis were randomized to internal mammary grafting (n = 59) versus bare-metal stenting (n = 62).

Principal Findings:

Baseline characteristics were similar between the two groups. At 10-years of follow-up, the primary outcome of death, myocardial infarction (MI), or urgent need for revascularization was 17% in the surgical group versus 42% in the stent group (p < 0.0001). This was driven by a need for more revascularizations in the stent group (30% vs. 5%). Death or MI occurred in 10% of both groups.

Interpretation:

For patients with isolated LAD disease, successful revascularization may be obtained with either technique. The need for subsequent procedures following bare-metal stent revascularization of the proximal LAD is increased compared with internal mammary grafting. The SIMA study results are consistent with other comparisons of percutaneous and surgical interventions, and provide a unique look at 10-year outcomes.

References:

Goy JJ, Kaufmann U, Hurni M, et al., on behalf of the SIMA Investigators. 10-Year Follow-Up of a Prospective Randomized Trial Comparing Bare-Metal Stenting With Internal Mammary Artery Grafting for Proximal, Isolated De Novo Left Anterior Coronary Artery Stenosis: The SIMA (Stenting Versus Internal Mammary Artery Grafting) Trial. J Am Coll Cardiol 2008;52:815-7.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease

Keywords: Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Coronary Stenosis, Ventricular Function, Left, Mammary Arteries, Constriction, Pathologic, Stents


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