A COMPARISON OF CORONARY-ARTERY STENTING WITH ANGIOPLASTY FOR ISOLATED STENOSIS OF THE PROXIMAL LEFT ANTERIOR DESCENDING CORONARY-ARTERY

Background Randomized studies have shown that the use of coronary-arte ry stenting as the initial treatment for coronary stenosis is associat ed with a lower risk of restenosis than is standard coronary angioplas ty. We prospectively investigated the efficacy of these two approaches in selected patients with isolated stenosis of the proximal left ante rior descending coronary artery. Methods A total of 120 patients with isolated stenosis of the proximal left anterior descending coronary ar tery were randomly assigned to stent implantation or standard coronary angioplasty. The primary clinical end points were the rate of procedu ral success (defined as residual stenosis of less than 50 percent and the absence of death, myocardial infarction, and the need for coronary -artery bypass surgery during the hospital stay) and the rate of event -free survival (defined as freedom from death, myocardial infarction, and the recurrence of angina) at 12 months. The angiographic end point was the rate of restenosis 12 months after the procedure. Results The two treatment groups did not differ significantly with respect to dem ographic, clinical, or angiographic characteristics. The rates of proc edural success were similar in the two groups of patients (95 percent in the stenting group vs. 93 percent in the angioplasty group, P = 0.9 8). The 12-month rates of event-free survival were 87 percent after st enting and 70 percent after angioplasty (P = 0.04). The rates of reste nosis were 19 percent after stent implantation and 40 percent after an gioplasty (P = 0.02). Conclusions In patients with symptomatic isolate d stenosis of the proximal left anterior descending coronary artery, s tenting had advantages over standard coronary angioplasty in that it w as associated with both a lower rate of restenosis and a better clinic al outcome. (C) 1997, Massachusetts Medical Society.