A prospective randomized trial comparing stenting with off-pump coronary surgery for high-grade XXXX in the proximal left anterior descending coronary artery: three-year follow-up.

@entity1 @entity4400 @entity64 @entity951 @entity583 @entity850 @entity34
OBJECTIVES: This study was done to identify the best treatment for an isolated high-grade @entity850 of the proximal left anterior descending coronary artery (LAD). BACKGROUND: Percutaneous transluminal coronary angioplasty with stenting (PCI) and off-pump coronary artery bypass grafting (surgery) are used to treat single-vessel disease of a high-grade @entity850 of the proximal LAD. Midterm results of both treatments are compared in this prospective randomized study. METHODS: In a single-center prospective trial, we randomly assigned 102 @entity1 with a high-grade @entity850 of the proximal LAD (American College of Cardiology/American Heart Association classification type @entity4400 ) to PCI (n = 51) or surgery (n = 51). Primary composite end point was freedom from Major Adverse Cardiac and Cerebrovascular Events (MACCE) at follow-up, including death, @entity583 , @entity64 , and repeat target vessel revascularization (TVR). Secondary end points were @entity951 class and need for antianginal medication at follow-up. Analysis was by intention-to-treat (ITT) and @entity34 ( @entity34 ). RESULTS: Mean follow-up time was three years (90% midrange, two to four years). Incidence of MACCE was 23.5% after PCI and 9.8% after surgery; p = 0.07 ITT (24.1% vs. 8.3%; p = 0.04 @entity34 ). After surgery a significantly lower @entity951 class (p = 0.02) and need for antianginal medication (p = 0.01) was found compared to PCI. Target vessel revascularization was 15.7% after PCI and 4.1% after surgery (p = 0.09). CONCLUSIONS: At three-year follow-up (range, two to four years), a trend in favor of surgery is observed in regard to MACCE-free survival with a significantly lower @entity951 status and significantly lower need for antianginal medication.
