Revascularization of the Left Anterior Descending Artery with Drug-Eluting Stents: Comparison with Arterial Off-Pump Surgery
DOI:
https://doi.org/10.1532/HSF98.20041063Abstract
Background: This study compared early results of left anterior descending artery (LAD) stenting using drug-eluting stents (Cypher) with off-pump bilateral internal thoracic arterial (BITA) grafting.
Methods: From June 2002 to June 2003, 200 consecutive patients underwent myocardial revascularization of the LAD territory, 100 by Cypher and 100 by BITA. The 2 groups were similar; however, left main disease and triple-vessel disease (20% and 75% versus 2% and 28%), age >70 (36% versus 17%) and intraaortic balloon pump (7% versus 0%) were more prevalent in the BITA group, and prior percutaneous coronary angiogplasty to the LAD was more prevalent in the Cypher group (28% versus 16%).
Results: The number of coronary vessels treated per patient in the BITA group was higher (2.7 versus 1.45, P < .01). Thirty-day mortality was 1% in the BITA group and 0% in the Cypher group. Mean follow-up was 12 months. There was 1 late death in each group. Angina returned in 32% of the Cypher group and in 1% of the BITA group. There were 9 reinterventions in the Cypher group: 7 coronary angioplasties (including 2 to the LAD) and 2 surgical interventions. There was neither recurrent angina nor reintervention in the surgical group.
Conclusions: Despite a higher risk profile of patients treated with BITA, their clinical outcome is better. A longer and more complete angiographic follow-up is required to determine the role of drug-eluting stents in LAD revascularization.
References
Moses JW, Leon MB, Popma JJ, et al. 2003. Sirolimus-eluting stents versus standard stents in patients with stenosis in native coronary artery. N Engl J Med 349:1315-23.nO'Keefe JH Jr, Kreamer TR, Jones PG, et al. 1999. Isolated left anterior descending coronary artery disease. Percutaneous transluminal coronary angioplasty versus stenting versus left internal mammary artery bypass grafting. Circulation 100(suppl I):II-114-8.nRodriguez A, Rodriguez Alemparte M, Baldi J, et al. 2003. Coronary stenting versus coronary bypass surgery in patients with multiple vessel disease and significant proximal LAD stenosis: results from the ERACI II study. Heart 89:184-8.nSmith SC Jr, Dove JT, Jacobs AK, et al. 2001. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)-executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions. Circulation 103:3019-41.nSofer D, Gurevitch J, Shapira I, et al. 1999. Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries. Ann Surg 229:585-90.nSousa JE, Costa MA, Abizaid A, et al. 2001. Lack of neointimal proliferation after implantation of sirolimus-coated stents in human coronary arteries: a quantitative coronary angiography and three-dimensional intravascular ultrasound study. Circulation 103:192-5.nTaggart DP, D'Amico R, Altman DG. 2001. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 358:870-5.nWeintraub WS, Jones EL, Craver JM, Guyon RA. 1994. Frequency of repeat coronary bypass or coronary angioplasty after coronary artery bypass surgery using saphenous vein grafts. Am J Cardiol 73:103-12.nBuxton BF, Komeda M, Fuller JA, Gordon I. 1998. Bilateral internal thoracic artery grafting may improve outcome of coronary artery surgery. Risk-adjusted survival. Circulation 98:II1-6.nCalafiore AM, Contini M, Vitolla G, et al. 2001. Bilateral internal thoracic artery grafting: long-term clinical and angiographic results of in situ versus Y grafts. J Thorac Cardiovasc Surg 120:990-8.nGurevitch J, Miller HI, Shapira I, et al. 1997. High-dose isosorbide dinitrate for myocardial revascularization with composite arterial grafts. Ann Thorac Surg 63:382-7.nHannan EL, Racz MJ, McCallister BD, et al. 1999. A comparison of three-year survival following coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 33:63-72.nHannan EL, Racz MJ, McCallister BD, et al. 1999. A comparison of three-year survival following coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 33:63-72.nHannan EL, Racz MJ, McCallister BD, et al. 1999. A comparison of three-year survival following coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 33:63-72.nJones RH, Kesler K, Phillips HR, et al. 1996. Long term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease. J Thorac Cardiovasc Surg 111:1013-25.nKimura BJ, Russo RJ, Bhargava V, et al. 1996. Atheroma morphology and distribution in proximal left anterior descending coronary artery: in vivo observations. J Am Coll Cardiol 27:825-31, 1996.nKlein LW, Weintraub WS, Agarwal JB, et al. 1986. Prognostic significance of severe narrowing of the proximal portion of the left anterior descending coronary artery. Am J Cardiol 58:42-6.nKouchoukos NT, Wareing TH, Murphy SF, Pelate C, Marshall WGJ. 1990. Risks of bilateral internal mammary artery bypass grafting. Ann Thorac Surg 49:210-7.nLytle BW, Blackstone EH, Loop FD, et al. 1999. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 117:855-72.nMorice-MC, Serruys PW, Sousa JE, et al. 2002. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 346:1773-80.n
