A comparison of coronary artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery: five year clinical follow up. Issue 6 (14th May 2004)

• Record Type: Journal Article
• Authors: Versaci, F; Gaspardone, A; Tomai, F; Proietti, I; Ghini, A S; Altamura, L; Andò, G; Crea, F; Gioffrè, P A; Chiariello, L
• Is Part Of: Heart. Volume 90:Issue 6(2004)
• Page Start: 672
• Page End: 675
• Publication Date: 2004-05-14
• Subjects: left anterior descending coronary artery -- coronary artery stenting -- balloon dilatation; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2003.020826
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Background: Stent implantation for isolated stenosis of the proximal left anterior descending coronary artery (LAD) with preserved left ventricular function has been found to have a better clinical and angiographic outcome at one year than balloon angioplasty (PTCA). Objective: To establish whether those results are maintained at five year follow up. Methods: Patients were followed at least every six months. For those who died during follow up, data were obtained from medical records. Main outcome measures: Freedom from death, non-fatal myocardial infarction, cerebrovascular accident, and repeated target lesion revascularisation. Secondary end points were revascularisation in a remote region and freedom from angina. Results: Follow up was complete in all patients. At five years, the primary end point was reached more often by patients randomised to stent implantation than to PTCA (80% v 53%; odds ratio (OR) 0.29 (95% confidence interval (CI) 0.13 to 0.69); p = 0.0034). In the PTCA group, 35% of patients underwent target lesion revascularisation v 15% in the stent group (OR 0.33, 95% CI 0.13 to 0.80; p = 0.014). There was a trend towards increased mortality in the PTCA group than in the stent group (17% v 7%; OR 0.36, 95% CI 0.10 to 1.21; p = 0.098). No significant differences were found between PTCA and stent groups for non-fatal myocardial infarction (8% v 5%; OR 0.58, 95% CI 0.13 to 2.54; p = 0.46) or cerebrovascular accident (2% v 0%). Conclusions: In patients with isolated stenosis of the proximal LAD, a five year clinical follow up confirmed a better outcome in those treated with stenting than with PTCA.