OBJECTIVE
To compare coronary artery bypass grafting (CABG) with percutaneous transluminal coronary
angioplasty (PTCA) in patients with proximal, isolated de novo left anterior descending
coronary artery disease and left ventricular ejection fraction of 45%.
PATIENTS AND METHODS
In the multicenter Stenting vs Internal Mammary Artery (SIMA) study, patients were
randomly assigned to PTCA and stent implantation or to CABG (using the internal mammary
artery). The primary clinical composite end point was event-free survival, including
death, myocardial infarction, and the need for additional revascularization. Secondary
end points were functional class, antianginal treatment, and quality of life. Analyses
were by intention to treat.
RESULTS
Of 123 patients who accepted randomization, 59 underwent CABG, and 62 were treated
with stent implantation (2 patients were excluded because of protocol violation).
At a mean ± SD follow-up of 2.4±o.9 years, a primary end point had occurred in 19
patients (31%) in the stent group and in 4 (7%) in the CABG group (P<.OOI). This significant
difference in clinical outcome is due to a higher incidence of additional revascularization
in the stent group, the incidence of death and myocardial infarction being similar
(7% vs 7%, respectively; P=.90). The functional class, need for antianginal drug, and quality-of-life assessment
showed no significant differences.
CONCLUSIONS
Both stent implantation and CABG are safe and highly effective treatments to relieve
symptoms in patients with isolated, proximal left anterior descending coronary artery
stenosis. Both are associated with a low and comparable incidence of death and myocardial
infarction. However, similar to PTCA alone, a percutaneous approach using elective
stent placement remains hampered by a higher need for repeated intervention because
of restenosis.
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Article Info
Footnotes
A complete list of the SIMA investigators appears at the end of this article.
This study was supported by a grant from the Swiss Foundation of Cardiology, Bern, Switzerland, and Johnson & Johnson, Warren, NJ.
Identification
Copyright
© 2000 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Left Anterior Descending Artery Stenosis: The Widow Maker RevisitedMayo Clinic ProceedingsVol. 75Issue 11
- PreviewStenosis of the proximal left anterior descending artery is regarded with considerable anxiety by patients, physicians, and surgeons alike. The appellation widow maker, which has been applied to this lesion (in part because of the large amount of myocardium that the left anterior descending artery supplies and its proximity to the distal left main coronary artery), has done nothing to allay this anxiety.
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