HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jan G. Grandjean Massimo A. Mariani Piet W. Boonstra Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Drenth, D. J. Articles by Boonstra, P. W. Search for Related Content PubMed PubMed Citation Articles by Drenth, D. J. Articles by Boonstra, P. W. Related Collections Coronary disease Minimally invasive surgery

J Thorac Cardiovasc Surg 2002;124:130-135
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery: Six months' angiographic and clinical follow-up of a prospective randomized study

From the Thoraxcentre of the Groningen University Hospital, Groningen, The Netherlands.

This study was supported in part by Cordis Europe, Waterloo, Belgium.

Received for publication Sept 27, 2001. Revisions requested Nov 13, 2001; revisions received Nov 27, 2001. Accepted for publication Dec 14, 2001. Address for reprints: P. W. Boonstra, MD, PhD, Department of Cardiothoracic Surgery, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands (E-mail: p.w.boonstra{at}thorax.azg.nl).

Objective: We sought to compare minimally invasive coronary artery bypass grafting (surgical intervention) with percutaneous transluminal coronary angioplasty with primary stenting (stenting) in patients having an isolated high-grade stenosis (American College of Cardiology/American Heart Association classification type B2 or C) of the proximal left anterior descending coronary artery. At 6 months, both procedures were compared on the basis of quantitative angiography and clinical outcome.
Methods: Both treatments were compared in a single-center, prospective, randomized study. The primary end point of this study was quantitative angiographic outcome at 6 months. The secondary end point was 6-month clinical outcome. Statistical analysis was performed in accordance with the intention-to-treat principle.
Results: From March 1997 to September 1999, patients with angina pectoris caused by an isolated high-grade stenosis of the proximal left anterior descending coronary artery were randomly assigned to surgical intervention (n = 51) or stenting (n = 51). At 6 months, quantitative coronary angiography showed an anastomotic stenosis rate of 4% after surgical intervention and a restenosis rate of 29% after stenting (P < .001). Periprocedural events did not significantly differ between surgical intervention and stenting. After surgical intervention, 2 patients died; no patients died after stenting. After 6 months, no significant difference was found for major adverse cardiac or cerebral events and need for repeat target vessel revascularization. After 6 months, return of angina pectoris, physical work capacity, and use of antianginal drugs did not significantly differ between treatments.
Conclusions: After 6 months, surgical intervention had a significantly better angiographic outcome than stenting in patients with an isolated high-grade stenosis of the proximal left anterior descending coronary artery. Clinical outcome did not significantly differ between treatments.

This article has been cited by other articles:

				H. Thiele, P. Neumann-Schniedewind, S. Jacobs, E. Boudriot, T. Walther, F.-W. Mohr, G. Schuler, and V. Falk Randomized Comparison of Minimally Invasive Direct Coronary Artery Bypass Surgery Versus Sirolimus-Eluting Stenting in Isolated Proximal Left Anterior Descending Coronary Artery Stenosis J. Am. Coll. Cardiol., June 23, 2009; 53(25): 2324 - 2331. [Abstract] [Full Text] [PDF]

				J. R. Kapoor, A. L. Gienger, R. Ardehali, R. Varghese, M. V. Perez, V. Sundaram, K. M. McDonald, D. K. Owens, M. A. Hlatky, and D. M. Bravata Isolated Disease of the Proximal Left Anterior Descending Artery: Comparing the Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Surgery J. Am. Coll. Cardiol. Intv., October 1, 2008; 1(5): 483 - 491. [Abstract] [Full Text] [PDF]

				D. M. Bravata, A. L. Gienger, K. M. McDonald, V. Sundaram, M. V. Perez, R. Varghese, J. R. Kapoor, R. Ardehali, D. K. Owens, and M. A. Hlatky Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery Ann Intern Med, November 20, 2007; 147(10): 703 - 716. [Abstract] [Full Text] [PDF]

				Z. Jaffery, M. Kowalski, W. D. Weaver, and S. Khanal A meta-analysis of randomized control trials comparing minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for stenosis of the proximal left anterior descending artery Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 691 - 697. [Abstract] [Full Text] [PDF]

				D. Bainbridge, D. Cheng, J. Martin, R. Novick, and The Evidence-based Peri-operative Clinical Outcome Does off-pump or minimally invasive coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with percutaneous coronary intervention? A meta-analysis of randomized trials J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 623 - 631. [Abstract] [Full Text] [PDF]

				M. Boodhwani, F. D. Rubens, F. W. Sellke, T. G. Mesana, and M. Ruel Mortality and myocardial infarction following surgical versus percutaneous revascularization of isolated left anterior descending artery disease: a meta-analysis Eur. J. Cardiothorac. Surg., January 1, 2006; 29(1): 65 - 70. [Abstract] [Full Text] [PDF]

				K D Dawkins, T Gershlick, M de Belder, A Chauhan, G Venn, P Schofield, D Smith, J Watkins, H H Gray, and Joint Working Group on Percutaneous Coronary Inter Percutaneous coronary intervention: recommendations for good practice and training Heart, December 1, 2005; 91(suppl_6): vi1 - vi27. [Abstract] [Full Text] [PDF]

				H. Thiele, S. Oettel, S. Jacobs, R. Hambrecht, P. Sick, J. F. Gummert, F. W. Mohr, G. Schuler, and V. Falk Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery: A 5-Year Follow-Up Circulation, November 29, 2005; 112(22): 3445 - 3450. [Abstract] [Full Text] [PDF]

				G. J. Murphy, A. J. Bryan, and G. D. Angelini Hybrid Coronary Revascularization in the Era of Drug-Eluting Stents Ann. Thorac. Surg., November 1, 2004; 78(5): 1861 - 1867. [Abstract] [Full Text] [PDF]

				D. J. Drenth, N. J.G.M. Veeger, J. G. Grandjean, M. A. Mariani, A. J. van Boven, and P. W. Boonstra Isolated high-grade lesion of the proximal LAD: a stent or off-pump LIMA? Eur. J. Cardiothorac. Surg., April 1, 2004; 25(4): 567 - 571. [Abstract] [Full Text] [PDF]

				F. W. LoGerfo, D. J. Drenth, N. J.G.M. Veeger, P. W. Boonstra, G. D'Ancona, H. Karamanoukian, R. E. Dragu, W. C. Wood, H. Thiele, F. W. Mohr, et al. Minimally Invasive Bypass Surgery N. Engl. J. Med., December 26, 2002; 347(26): 2165 - 2168. [Full Text] [PDF]

				D. J. Drenth, N. J. G. M. Veeger, J. B. Winter, J. G. Grandjean, M. A. Mariani, A. d J. Boven van, and P. W. Boonstra 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 J. Am. Coll. Cardiol., December 4, 2002; 40(11): 1955 - 1960. [Abstract] [Full Text] [PDF]