Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery: 10-Year Follow-Up of a Randomized Trial

Study Questions:

What is the long-term safety and comparative effectiveness of percutaneous coronary intervention (PCI) and minimally invasive direct coronary artery bypass (MIDCAB) surgery for the treatment of patients with isolated high-grade stenosis of the proximal left anterior descending (LAD) artery?

Methods:

This was a randomized trial in which patients with ≥75% diameter stenosis on visual assessment of the proximal LAD were assigned to PCI with bare-metal stenting (n = 110) or MIDCAB (n = 110). Assignment was not blinded. At 10 years, data were obtained with respect to the primary endpoint (death, myocardial infarction, target vessel revascularization [TVR]).

Results:

There were no significant differences in the binary composite endpoint (47% vs. 36%; p = 0.12) between PCI and MIDCAB. All-cause mortality did not differ between the two treatment groups at 10-year follow-up (PCI 23% vs. MIDCAB 23%, p = 1.00). A higher TVR rate in the PCI group (34% vs. 11%; p < 0.01) was observed, primarily during the first 6 months following stenting. Anginal symptom improvement was similar between treatment groups.

Conclusions:

PCI and MIDCAB for isolated proximal LAD disease yielded similar long-term outcomes, but TVR was more frequently necessary following PCI with bare-metal stenting.

Perspective:

At 10-year follow-up, stenting with BMS or MIDCAB for isolated high-grade proximal LAD disease are associated with similar long-term outcomes. PCI is associated with a higher TVR rate, primarily in the first 6 months following intervention. The results of this long-term analysis are less relevant in the current landscape where drug-eluting stents are more frequently used, and would be expected to narrow this difference in TVR between treatment strategies.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Aortic Surgery, Cardiac Surgery and SIHD, Chronic Angina

Keywords: Myocardial Infarction, Follow-Up Studies, Coronary Restenosis, Coronary Stenosis, Drug-Eluting Stents, Coronary Vessels, Coronary Artery Bypass, Cardiac Surgical Procedures, Angioplasty, Percutaneous Coronary Intervention


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