Comparison of stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery.

Minimally invasive bypass surgery and coronary-artery stenting are both accepted treatments for isolated stenosis of the proximal left anterior descending coronary artery. We compared the clinical outcomes after these two procedures. A total of 220 symptomatic patients with high-grade lesions in the proximal left anterior descending coronary artery were randomly assigned to treatment--110 to surgery and 110 to stenting. The combined clinical end point was freedom from major adverse cardiac events, such as death from cardiac causes, myocardial infarction, and the need for repeated revascularization of the target lesion within six months. A major adverse cardiac event occurred in 31 percent of patients after stenting, as compared with 15 percent in the surgery group (P=0.02). The difference was predominantly due to a higher rate of repeated revascularization of the target vessel for restenosis after stenting (29 percent vs. 8 percent, P=0.003). The combined rates of death and myocardial infarction did not differ significantly between groups (3 percent in the stenting group and 6 percent in the surgery group, P=0.50). Adverse events occurred more frequently after surgery. The percentage of patients free from angina after six months was 79 percent in the surgery group, as compared with 62 percent in the stenting group (P=0.03). In patients with isolated high-grade lesions of the proximal left anterior descending artery, both minimally invasive bypass surgery and stenting are effective. Stenting yields excellent short-term results with fewer periprocedural adverse events, but surgery is superior with regard to the need for repeated intervention in the target vessel and freedom from angina at six months of follow-up.

Diegeler A ，Thiele H ，Falk V ，Hambrecht R ，Spyrantis N ，Sick P ，Diederich KW ，Mohr FW ，Schuler G ... -  《-》

A comparison of coronary-artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery.

Versaci F ，Gaspardone A ，Tomai F ，Crea F ，Chiariello L ，Gioffrè PA ... -  《NEW ENGLAND JOURNAL OF MEDICINE》

Randomized comparison of minimally invasive direct coronary artery bypass surgery versus sirolimus-eluting stenting in isolated proximal left anterior descending coronary artery stenosis.

Thiele H ，Neumann-Schniedewind P ，Jacobs S ，Boudriot E ，Walther T ，Mohr FW ，Schuler G ，Falk V ... -  《-》

Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease.

Serruys PW ，Unger F ，Sousa JE ，Jatene A ，Bonnier HJ ，Schönberger JP ，Buller N ，Bonser R ，van den Brand MJ ，van Herwerden LA ，Morel MA ，van Hout BA ，Arterial Revascularization Therapies Study Group ... -  《NEW ENGLAND JOURNAL OF MEDICINE》

Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts. Saphenous Vein De Novo Trial Investigators.

Savage MP ，Douglas JS Jr ，Fischman DL ，Pepine CJ ，King SB 3rd ，Werner JA ，Bailey SR ，Overlie PA ，Fenton SH ，Brinker JA ，Leon MB ，Goldberg S ... -  《NEW ENGLAND JOURNAL OF MEDICINE》