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 Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by O’Keefe, J. H. Articles by McCallister, B. D. Search for Related Content PubMed PubMed Citation Articles by O’Keefe, J. H., Jr Articles by McCallister, B. D. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Coronary Artery Bypass Surgery Related Collections Catheter-based coronary and valvular interventions: other Catheter-based coronary interventions: stents CV surgery: coronary artery disease Chronic ischemic heart disease

(Circulation. 1999;100:II-114.)
© 1999 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Isolated Left Anterior Descending Coronary Artery Disease

Percutaneous Transluminal Coronary Angioplasty Versus Stenting Versus Left Internal Mammary Artery Bypass Grafting

James H. O’Keefe, Jr, MD; Thomas R. Kreamer, MD; Philip G. Jones; James L. Vacek, MD; Michael E. Gorton, MD; Gregory F. Muehlebach, MD; Barry D. Rutherford, MD; Ben D. McCallister, MD

From the Mid America Heart Institute, Kansas City, Mo.

Background—Single-vessel coronary artery disease is usually treated with PTCA; however, this approach when applied to the left anterior descending coronary artery (LAD) is hampered by high restenosis rates, often approaching 50%. Coronary stenting (STENT) and left internal mammary artery bypass grafting of the LAD (LIMA-LAD) are other options that have been successfully used for single-vessel LAD disease. The optimal mode of revascularization for patients with isolated single-vessel LAD disease is unclear. The purpose of the present study was to examine PTCA versus STENT versus LIMA-LAD with respect to short- and intermediate-term outcomes.

Methods and Results—This was an observational retrospective cohort study comparing in-hospital and intermediate-term outcomes and functional class among patients with isolated single-vessel LAD disease revascularization. Consecutive eligible patients were grouped according to their initial revascularization procedure and systematically followed up. A total of 704 patients qualified for the study: 469 in the PTCA group, 137 in the STENT group, and 98 in the LIMA-LAD group. Follow-up data were complete for 97% of patients and averaged 27±13 months. In-hospital mortality for the PTCA, STENT, and LIMA-LAD groups was 1.1%, 0%, and 0% (P=0.51), respectively. Median hospital stays after the procedure for the respective treatment groups were 1, 1, and 5 days (P<0.001), and occurrences of in-hospital myocardial infarction were 0.9%, 1.5%, and 1.0% (P=NS). Repeat revascularization procedures were performed in 30%, 24%, and 5% of the PTCA, STENT, and LIMA-LAD groups (P=<0.001 for LIMA-LAD versus other groups, P=0.11 for PTCA versus STENT). Actuarial 2-year mortality was 3.9%, 2.6%, and 1% in the PTCA, STENT, and LIMA-LAD groups (P=0.33).

Conclusions—Revascularization for isolated LAD disease using PTCA, STENT, or LIMA-LAD results in low in-hospital adverse event rates and good long-term results. Repeat procedures are required less often after LIMA-LAD than after either PTCA or STENT. Long-term mortality was not statistically different, but the trend was for the lowest mortality with LIMA-LAD, a somewhat higher mortality with STENT, and the highest mortality with PTCA.

Key Words: angioplasty • stents • grafting • coronary disease • bypass • revascularization