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(Circulation. 2005;112:3445-3450.)
© 2005 American Heart Association, Inc.

Interventional Cardiology

Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

A 5-Year Follow-Up

Holger Thiele, MD; Stefan Oettel, BS; Stephan Jacobs, MD; Rainer Hambrecht, MD; Peter Sick, MD; Jan F. Gummert, MD; Friedrich W. Mohr, MD; Gerhard Schuler, MD; Volkmar Falk, MD

From the University of Leipzig–Heart Center, Departments of Cardiology (H.T., S.O., R.H., P.S., G.S.) and Cardiac Surgery (S.J., J.F.G., F.W.M., V.F.), Leipzig, Germany.

Correspondence to Holger Thiele, MD, Department of Internal Medicine/Cardiology, University of Leipzig–Heart Center, Strümpellstr 39, 04289 Leipzig, Germany. E-mail thielh{at}medizin.uni-leipzig.de

Received July 25, 2005; revision received August 29, 2005; accepted October 3, 2005.

Background— Randomized trials comparing stenting with minimally invasive direct coronary artery bypass surgery in patients with isolated proximal left anterior descending lesions have shown a significantly higher reintervention rate for stenting and similar results for mortality and reinfarction at short-term follow-up. Long-term follow-up data are sparse.

Methods and Results— Patients with isolated proximal left anterior descending stenosis were randomized to either surgery (n=110) or bare-metal stenting (n=110). At 5 years, follow-up data were obtained with respect to the primary end point of death, reinfarction, or repeated target vessel revascularization. Clinical symptoms were assessed by the Canadian Cardiovascular Society (CCS) classification. Follow-up information was completed for 216 patients (98.2%), and mean follow-up was 5.6±1.2 years. With respect to mortality (surgery, 12%; stenting, 10%; P=0.54) and reinfarctions (surgery, 7%; stenting, 5%; P=0.46), there were no differences between treatment strategies. The need for repeated target vessel revascularization was significantly higher after stenting (32%) compared with surgery (10%; P<0.001). Clinical symptoms improved significantly in both treatment groups compared with baseline; however, there was a favorable trend for surgery (stenting: CCS, 2.6±0.9 to 0.5±0.8, P<0.001; surgery: CCS, 2.6±0.9 to 0.3±0.6, P<0.001; P=0.05, stenting versus surgery).

Conclusions— At the 5-year follow-up, minimally invasive bypass surgery and bare-metal stenting showed similar results for the end points of mortality and reinfarctions. However, the reintervention rate is higher after stenting, and the relief in clinical symptoms is slightly better after surgery.

Key Words: bypass • coronary disease • revascularization • stents • surgery

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