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


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.


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.


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.


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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