OBJECTIVES: This study was designed to compare the long-term clinical outcome of coronary artery bypass grafting (CABG) with intracoronary stenting of patients with isolated proximal left anterior descending coronary artery. BACKGROUND: Although numerous trials have compared coronary angioplasty with bypass surgery, none assessed the clinical evaluation in the long term. METHODS: We evaluated the 10-year clinical outcome in the SIMA (Stent versus Internal Mammary Artery grafting) trial. Patients were randomly assigned to stent implantation versus CABG. RESULTS: Of 123 randomized patients, 59 underwent CABG and 62 received a stent (2 patients were excluded). Follow-up after 10 years was obtained for 98% of the randomized patients. Twenty-six patients (42%) in the percutaneous coronary intervention group and 10 patients (17%) in the CABG group reached an end point (p < 0.001). This difference was due to a higher need for additional revascularization. The incidences of death and myocardial infarction were identical at 10%. Progression of the disease requiring additional revascularization was rare (5%) and was similar for the 2 groups. Stent thrombosis occurred in 2 patients (3%). Angina functional class showed no significant differences between the 2 groups. CONCLUSIONS: Both stent implantation and CABG are safe and highly effective in relieving symptoms in patients with isolated, proximal left anterior descending coronary artery stenosis. Stenting with bare-metal stents is associated with a higher need for repeat interventions. The long-term prognosis for these patients is excellent with either mode of revascularization.
RCT Entities:
OBJECTIVES: This study was designed to compare the long-term clinical outcome of coronary artery bypass grafting (CABG) with intracoronary stenting of patients with isolated proximal left anterior descending coronary artery. BACKGROUND: Although numerous trials have compared coronary angioplasty with bypass surgery, none assessed the clinical evaluation in the long term. METHODS: We evaluated the 10-year clinical outcome in the SIMA (Stent versus Internal Mammary Artery grafting) trial. Patients were randomly assigned to stent implantation versus CABG. RESULTS: Of 123 randomized patients, 59 underwent CABG and 62 received a stent (2 patients were excluded). Follow-up after 10 years was obtained for 98% of the randomized patients. Twenty-six patients (42%) in the percutaneous coronary intervention group and 10 patients (17%) in the CABG group reached an end point (p < 0.001). This difference was due to a higher need for additional revascularization. The incidences of death and myocardial infarction were identical at 10%. Progression of the disease requiring additional revascularization was rare (5%) and was similar for the 2 groups. Stent thrombosis occurred in 2 patients (3%). Angina functional class showed no significant differences between the 2 groups. CONCLUSIONS: Both stent implantation and CABG are safe and highly effective in relieving symptoms in patients with isolated, proximal left anterior descending coronary artery stenosis. Stenting with bare-metal stents is associated with a higher need for repeat interventions. The long-term prognosis for these patients is excellent with either mode of revascularization.
Authors: Ralf E Harskamp; Judson B Williams; Michael E Halkos; Renato D Lopes; Jan G P Tijssen; T Bruce Ferguson; Robbert J de Winter Journal: J Thorac Cardiovasc Surg Date: 2014-03-20 Impact factor: 5.209
Authors: Mario Gaudino; Irbaz Hameed; Michael E Farkouh; Mohamed Rahouma; Ajita Naik; N Bryce Robinson; Yongle Ruan; Michelle Demetres; Giuseppe Biondi-Zoccai; Dominick J Angiolillo; Emilia Bagiella; Mary E Charlson; Umberto Benedetto; Marc Ruel; David P Taggart; Leonard N Girardi; Deepak L Bhatt; Stephen E Fremes Journal: JAMA Intern Med Date: 2020-12-01 Impact factor: 21.873
Authors: Ming Zhang; Raviteja R Guddeti; Yasushi Matsuzawa; Jaskanwal D S Sara; Taek-Geun Kwon; Zhi Liu; Tao Sun; Seung-Jin Lee; Ryan J Lennon; Malcolm R Bell; Hartzell V Schaff; Richard C Daly; Lilach O Lerman; Amir Lerman; Chaim Locker Journal: J Am Heart Assoc Date: 2016-09-24 Impact factor: 5.501