Isolated left anterior descending coronary artery disease - Percutaneous transluminal coronary angioplasty versus stenting versus left internal mammary artery bypass grafting

Background-Single-vessel coronary artery disease is usually treated with PT CA, however, this approach when applied to the left anterior descending cor onary artery (LAD) is hampered by high restenosis rates, often approaching 50%. Coronary stenting (STENT) and left internal mammary artery bypass graf ting of the LAD (LIMA-LAD) are other options that have been successfully us ed for single-vessel LAD disease. The optimal mode of revascularization for patients with isolated single-vessel LAD disease is unclear. The purpose o f the present study was to examine PTCA versus STENT versus LIMA-LAD with r espect to short- and intermediate-term outcomes. Methods and Results-This was an observational retrospective cohort study co mparing in-hospital and intermediate-term outcomes and functional class amo ng patients with isolated single-vessel LAD disease revascularization. Cons ecutive eligible patients were grouped according to their initial revascula rization procedure and systematically followed up. A total of 704 patients qualified for the study: 469 in the PTCA group, 137 in the STENT group, and 98 in the LIMB-LAD group. Follow-up data were complete for 97% of patients and averaged 27+/-13 months. in-hospital mortality for the PTCA, STENT, an d LIMA-LAD groups was 1.1%, 0%, and 0% (P=0.51), respectively. Median hospi tal stays after the procedure for the respective treatment groups were 1, 1 , and 5 days (P<0.001), and occurrences of in-hospital myocardial infarctio n were 0.9%, 1.5%, and 1.0% (P=NS). Repeat revascularization procedures wer e performed in 30%, 24%, and 5% of the PTCA, STENT, and LIMA-LAD groups (P= <0.001 for LIMA-LAD versus other groups, P=0.11 for PTCA versus STENT). Act uarial 2-year mortality was 3.9%, 2.6%, and 1% in the PTCA, STENT, and LIMA -LAD groups (P=0.33). Conclusions-Revascularization for isolated LAD disease using PTCA, STENT, o r LIMA-LAD results in low in-hospital adverse event rates and good long-ter m results. Repeat procedures are required less often after LIMA-LAD than af ter either PTCA or STENT. Long-term mortality was not statistically differe nt, but the trend was for the lowest mortality with LIMA-LAD, a somewhat hi gher mortality with STENT, and the highest mortality with PTCA.