(Circulation. 1999;99:3255-3259.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Five-Year Outcome in Patients With Isolated Proximal Left Anterior Descending Coronary Artery Stenosis Treated by Angioplasty or Left Internal Mammary Artery Grafting
A Prospective Trial
From the Division of Cardiology (J.-J.G., E.E., C.M., P.V., J.-C.S., P.U., L.K.), Service of Cardiovascular Surgery (M.H., F.S., P.R., L.v.S.), and Institute of Social and Preventive Medicine (B.B.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Correspondence to Professeur Jean-Jacques Goy, Division of Cardiology, BH-10, CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland. E-mail jean-jacques.goy{at}chuv.hospvd.ch
Background—Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) improve the clinical status of patients with isolated proximal left anterior descending coronary artery stenosis. At 2 years, only additional revascularization was more frequently required after PTCA.
Methods and Results—We monitored 134 patients randomized to PTCA
(n=68) or CABG (n=66) for 
5 years. End points were death, myocardial
infarction, need for additional revascularization,
clinical status, and medical treatment. At 5 years, 6 patients (9%)
had died in the PTCA group versus 2 (3%) in the CABG group
(P=0.12). One patient in each group died of a cardiac
cause. Myocardial infarction was more frequent after PTCA (15% versus
4%; P=0.0001), but Q-wave infarction was not (6% in
the PTCA group versus 3% in the CABG group; P=0.8).
Additional revascularization was required in 38%
of patients in the PTCA group versus 9% in the CABG group
(P=0.0001). Functional status was comparable, with 6%
of patients after PTCA and 3% after CABG in functional class III or
IV. Finally, after PTCA or CABG, 62% and 91% of patients,
respectively, were free of events (P=0.0001).
Conclusions—The 5-year prognosis of patients with isolated proximal left anterior descending coronary artery stenosis is good. Both PTCA and CABG improve clinical status, but revascularization was needed more frequently after PTCA. There is an excess incidence of non–Q-wave myocardial infarction in the PTCA group that does not affect the vital or symptomatic outcome.
Key Words: angioplasty • bypass • stenosis • prognosis • revascularization
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