Outcome five years after percutaneous transluminal coronary angioplasty or coronary artery bypass grafting for significant narrowing limited to the left anterior descending coronary artery

Abstract

Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) are both used widely for angina but information about their comparative efficacy is limited. This study compared the outcome of 358 consecutive patients undergoing initial revascularization for significant narrowing of the left anterior descending artery (LAD) by PTCA (n = 254) or CABG (n = 104) from 1987 to 1989. PTCA was successful in 93% but complicated by urgent CABG in 3%. A left internal mammary graft was used in 88% of those having elective CABG. There was 1 perioperative death. Follow-up data were obtained after a median interval of 5.5 years (maximum 7.1). Rates for freedom from death (97% PTCA vs 93% CABG, p = 0.06) were similar, but CABG patients had greater rates for freedom from chest pain recurrence (74% CABG vs 48% PTCA, p < 0.0001), myocardial infarction (98% vs 92%, p = 0.04), and from need for further revascularization (99% vs 67%, p < 0.0001). Both groups achieved similar status, with 81% of PTCA and 90% of CABG patients having angina no worse than functional class I. Quality-of-life index was high for both groups ( 0.983 ± 0.034 1.000 vs 0.987 ± 0.032 1.000 , p = 0.3). Both PTCA and CABG result in excellent survival, functional ability, and quality of life, but patients undergoing PTCA require more procedures to achieve this.