Diegeler Anno, Thiele Holger, Falk Volkmar, Hambrecht Rainer, Spyrantis Niki, Sick Peter, Diederich Klaus W, Mohr Friedrich W, Schuler Gerhard
Department of Cardiac Surgery, University of Leipzig Heart Center, Leipzig, Germany.
N Engl J Med. 2002 Aug 22;347(8):561-6. doi: 10.1056/NEJMoa013563.
Minimally invasive bypass surgery and coronary-artery stenting are both accepted treatments for isolated stenosis of the proximal left anterior descending coronary artery. We compared the clinical outcomes after these two procedures.
A total of 220 symptomatic patients with high-grade lesions in the proximal left anterior descending coronary artery were randomly assigned to treatment--110 to surgery and 110 to stenting. The combined clinical end point was freedom from major adverse cardiac events, such as death from cardiac causes, myocardial infarction, and the need for repeated revascularization of the target lesion within six months.
A major adverse cardiac event occurred in 31 percent of patients after stenting, as compared with 15 percent in the surgery group (P=0.02). The difference was predominantly due to a higher rate of repeated revascularization of the target vessel for restenosis after stenting (29 percent vs. 8 percent, P=0.003). The combined rates of death and myocardial infarction did not differ significantly between groups (3 percent in the stenting group and 6 percent in the surgery group, P=0.50). Adverse events occurred more frequently after surgery. The percentage of patients free from angina after six months was 79 percent in the surgery group, as compared with 62 percent in the stenting group (P=0.03).
In patients with isolated high-grade lesions of the proximal left anterior descending artery, both minimally invasive bypass surgery and stenting are effective. Stenting yields excellent short-term results with fewer periprocedural adverse events, but surgery is superior with regard to the need for repeated intervention in the target vessel and freedom from angina at six months of follow-up.
微创搭桥手术和冠状动脉支架置入术都是治疗孤立性左前降支冠状动脉近端狭窄的公认方法。我们比较了这两种手术的临床结果。
总共220例有症状的左前降支冠状动脉近端严重病变患者被随机分配接受治疗——110例接受手术，110例接受支架置入术。联合临床终点是无主要不良心脏事件，如心源性死亡、心肌梗死以及在六个月内对靶病变进行重复血运重建的需要。
支架置入术后31%的患者发生了主要不良心脏事件，而手术组为15%（P = 0.02）。这种差异主要是由于支架置入术后因再狭窄而对靶血管进行重复血运重建的发生率较高（29%对8%，P = 0.003）。两组的死亡和心肌梗死联合发生率无显著差异（支架置入组为3%，手术组为6%，P = 0.50）。手术后不良事件更频繁发生。六个月后手术组无心绞痛的患者百分比为79%，而支架置入组为62%（P = 0.03）。
在孤立性左前降支近端严重病变患者中，微创搭桥手术和支架置入术均有效。支架置入术产生了出色的短期结果，围手术期不良事件较少，但在靶血管重复干预的必要性以及随访六个月时无心绞痛方面，手术更具优势。
