PMID- 12475455
OWN - NLM
STAT- MEDLINE
DCOM- 20030115
LR  - 20220311
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 40
IP  - 11
DP  - 2002 Dec 4
TI  - A prospective randomized trial comparing stenting with off-pump coronary surgery 
      for high-grade stenosis in the proximal left anterior descending coronary artery: 
      three-year follow-up.
PG  - 1955-60
AB  - OBJECTIVES: This study was done to identify the best treatment for an isolated 
      high-grade stenosis of the proximal left anterior descending coronary artery 
      (LAD). BACKGROUND: Percutaneous transluminal coronary angioplasty with stenting 
      (PCI) and off-pump coronary artery bypass grafting (surgery) are used to treat 
      single-vessel disease of a high-grade stenosis of the proximal LAD. Midterm 
      results of both treatments are compared in this prospective randomized study. 
      METHODS: In a single-center prospective trial, we randomly assigned 102 patients 
      with a high-grade stenosis of the proximal LAD (American College of 
      Cardiology/American Heart Association classification type B2 or C) to PCI (n = 
      51) or surgery (n = 51). Primary composite end point was freedom from Major 
      Adverse Cardiac and Cerebrovascular Events (MACCE) at follow-up, including death, 
      myocardial infarction, cerebrovascular accident, and repeat target vessel 
      revascularization (TVR). Secondary end points were angina pectoris class and need 
      for antianginal medication at follow-up. Analysis was by intention-to-treat (ITT) 
      and received treatment (RT). RESULTS: Mean follow-up time was three years (90% 
      midrange, two to four years). Incidence of MACCE was 23.5% after PCI and 9.8% 
      after surgery; p = 0.07 ITT (24.1% vs. 8.3%; p = 0.04 RT). After surgery a 
      significantly lower angina pectoris class (p = 0.02) and need for antianginal 
      medication (p = 0.01) was found compared to PCI. Target vessel revascularization 
      was 15.7% after PCI and 4.1% after surgery (p = 0.09). CONCLUSIONS: At three-year 
      follow-up (range, two to four years), a trend in favor of surgery is observed in 
      regard to MACCE-free survival with a significantly lower angina pectoris status 
      and significantly lower need for antianginal medication.
FAU - Drenth, Derk J
AU  - Drenth DJ
AD  - Thoraxcentre of the Groningen University Hospital, Groningen, The Netherlands.
FAU - Veeger, Nic J G M
AU  - Veeger NJ
FAU - Winter, Jobst B
AU  - Winter JB
FAU - Grandjean, Jan G
AU  - Grandjean JG
FAU - Mariani, Massimo A
AU  - Mariani MA
FAU - Boven van, Ad J
AU  - Boven van AJ
FAU - Boonstra, Piet W
AU  - Boonstra PW
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - *Angioplasty, Balloon, Coronary/mortality
MH  - Arteries/*pathology/*surgery
MH  - Blood Vessel Prosthesis Implantation/mortality
MH  - Coronary Angiography
MH  - Coronary Artery Bypass/mortality
MH  - Coronary Stenosis/diagnostic imaging/epidemiology/*therapy
MH  - Coronary Vessels/*pathology/*surgery
MH  - Disease-Free Survival
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/epidemiology/etiology
MH  - Prospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - *Stents
MH  - Treatment Outcome
EDAT- 2002/12/12 04:00
MHDA- 2003/01/16 04:00
CRDT- 2002/12/12 04:00
PHST- 2002/12/12 04:00 [pubmed]
PHST- 2003/01/16 04:00 [medline]
PHST- 2002/12/12 04:00 [entrez]
AID - S0735109702025366 [pii]
AID - 10.1016/s0735-1097(02)02536-6 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2002 Dec 4;40(11):1955-60. doi: 10.1016/s0735-1097(02)02536-6.