Abstract 2044: Follow-up At 10 Years Of The Prospective Randomized Trial Comparing Stenting To Internal Mammary Artery Grafting For Proximal, Isolated De Novo Left Anterior Coronary Artery Stenosis: The Sima Trial.
Objectives: To compare at 10 years coronary artery bypass grafting (CABG) with percutaneous coronary intervention and stent implantation (S) in patients with proximal, isolated de novo left anterior descending (LAD) coronary artery disease.
Method: The patients were randomly assigned to S or to CABG. The primary clinical composite end point was event-free survival, including death, myocardial infarction, and the need for additional revascularization. Secondary end points were functional class, anti-anginal treatment, and quality of life. The follow-up was obtained for 121 pts at 10 years (2 lost of follow-up).
Results: Of 123 randomized patients, 59 underwent CABG, and 62 S (2 patients were excluded because of protocol violation). At 10 years follow-up, a primary end point had occurred in 24 patients (39%) in the S group and in 10 (17%) in the CABG group (P<.001). This significant difference in clinical outcome is due to a higher incidence of additional revascularization in the stent group. The incidence of death and myocardial infarction being similar (10% vs 10%, respectively; P=.90). Progression of the disease requiring additional revascularization was rare and similar for the 2 groups (5% for both group). Stent thrombosis (1 acute and 1 late) occurred in 2 pts (3%). The functional class showed no significant differences between the 2 groups. The event-free survival for cardiac death and MI was 95% after S and 95% after CABG (p=n.s)
Conclusion: Both stent implantation and CABG are safe and highly effective treatments to relieve symptoms in patients with isolated, proximal left anterior descending coronary artery stenosis. The long-term prognosis remains very favourable with an overall survival of 91%. Progression of the disease is relatively rare. However, elective stent placement remains hampered by a higher need for repeated intervention because of restenosis.