Treatment of left anterior descending coronary artery stenosis: stent or surgery

Abstract

Drug-eluting stents have emerged as a solution to the problem of restenosis after bare-metal stent implantation, as an alternative to off-pump coronary bypass, for isolated left anterior descending coronary artery lesions at short-term follow-up. However, long-term follow-up is yet to be defined. From January to December 2004, 64 consecutive patients underwent myocardial revascularization: 31 by drug-eluting stents and 33 by off-pump coronary bypass. The primary endpoint was angiographic outcome, and the secondary endpoint was clinical outcome at 5 years. There was no early or late mortality in either group. Hospital stay was significantly shorter in the stent group (2.5 ± 2.1 vs. 7.1 ± 4.9 days, p = 0.003). Long-term patency was higher and major adverse cardiac events (recurrence of angina and revascularization of target vessel) were encountered less frequently in the coronary bypass group, although not significantly. The 5-year follow-up showed no significant difference between the off-pump coronary bypass and stent groups for the primary and secondary endpoints. As a significant difference between treatment options is lacking, decision-making for appropriate treatment in this group of patients requires the collaboration of cardiologists and cardiovascular surgeons and an individual approach, to achieve successful long-term outcomes.