High-grade Stenosis of Proximal LAD Responds Better to CABG Than Stenting

In patients with high-grade stenosis in the proximal left anterior descending coronary artery (LAD), outcomes after coronary artery bypass grafting (CABG) are better at 3-year follow-up than after angioplasty, according to a report in the Journal of the American College of Cardiology for December 4.

In a prospective, randomized comparison trial initiated in 1997, 102 patients underwent percutaneous transluminal coronary angioplasty with primary stenting (PCI) or off-pump CABG. All subjects were eligible for either procedure, Dr. Piet W. Boonstra, of University Hospital Groningen in the Netherlands, and colleagues indicate.

At follow-up ranging from 2 to 4 years, the rate of major adverse cardiac and cerebrovascular events–including death, myocardial infarction, cerebrovascular accident, and repeat target vessel revascularization–was 24.1% among those treated with PCI and 8.3% among those who underwent CABG (p = 0.04).

Revascularization treatment was required significantly less often by those originally treated with CABG (p = 0.09). Furthermore, angina pectoris class and need for antianginal medication were significantly lower for those who had surgery (p = 0.02 and 0.01, respectively).

Dr. Boonstra’s team points out that, since the start of the study, use of glycoprotein IIb/IIIa receptor blockers, newer stent designs and drug-eluting stents have become common. How the two treatments compare with the introduction of these improvements remains to be seen.

J Am Coll Cardiol 2002;40:1955-1960.