Stenting and Minimally Invasive Bypass Surgery Equally Effective for Isolated High-grade Lesions

Minimally invasive bypass surgery and coronary stenting are equally effective in managing patients with isolated high-grade lesions of the proximal left anterior descending artery.

However, although stenting yields excellent short-term results with fewer periprocedural adverse events, surgery proves better at six months in terms of freedom from angina and need for repeated procedures, a randomised study in Germany has found.

High-grade stenosis of the proximal left anterior descending coronary artery in patients with single-vessel disease is linked with a significantly worse prognosis than lesions at any other location.

Both minimally invasive bypass surgery and coronary-artery stenting are accepted treatments. Dr. Anno Diegeler and colleagues from the University of Leipzig Heart Center, Leipzig sought to compare the two procedures in terms of clinical outcomes.

Study participants were 220 symptomatic patients with high-grade lesions in the proximal left anterior descending coronary artery, 110 of whom were randomly assigned to surgery and 110 to stenting.

Doctors defined the combined clinical end point as freedom from major adverse cardiac events, such as death from cardiac causes, myocardial infarction and need for repeated target-lesion revascularization within six months.

After stenting, 31 percent of patients suffered a major adverse cardiac event versus 15 percent of the patients after surgery.

This difference was found to be predominantly the result of a higher rate of repeated revascularization of the target vessel for restenosis after stenting (29 percent versus eight percent).

Combined rates of death and myocardial infarction were similar between the two groups, at three percent in the stenting and six percent in the surgery group.

Surgery was more frequently followed by adverse events than was stenting.

After six months, 79 percent of patients in the surgery group as compared with 62 percent in the stenting group were free from angina.

N Engl J Med 2002;347:561-566