OUTCOME 5 YEARS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY OR CORONARY-ARTERY BYPASS CRAFTING FOR SIGNIFICANT HARROWING LIMITED TO THE LEFT ANTERIOR DESCENDING CORONARY-ARTERY

Percutaneous transluminal coronary angioplasty (PTCA) and coronary art ery bypass grafting (CABG) are both used widely for angina but informa tion about their comparative efficacy is limited. This study compared the outcome of 358 consecutive patients undergoing initial revasculari zation for significant narrowing of the left anterior descending arter y (LAD) by PTCA (n = 254) or CABG (n = 104) from 1987 to 1989. PTCA wa s successful in 93% but complicated by urgent CABG in 3%. A left inter nal mammary graft was used in 88% of those having elective CABG. There was 1 perioperative death. Follow-up data were obtained after a media n interval of 5.5 years (maximum 7.1). Rates for freedom from death (9 7% PTCA vs 93% CABG, p = 0.06) were similar, but CABG patients had gre ater rates for freedom from chest pain recurrence (74% CABG vs 48% PTC A, p <0.0001), myocardial infarction (98% vs 92%, p = 0.04), and from need for further revascularization (99% vs 67%, p <0.0001). Both group s achieved similar status, with 81% of PTCA and 90% of CABG patients h aving angina no worse than functional class I. Quality-of-life index w as high for both groups (0.983 +/- 0.034/1.000 vs 0.987 +/- 0.032/1.00 0, p = 0.3). Both PTCA and CABG result in excellent survival, function al ability, and quality of life, but patients undergoing PTCA require more procedures to achieve this.