Drenth Derk J, Veeger Nic J G M, Winter Jobst B, Grandjean Jan G, Mariani Massimo A, Boven van Ad J, Boonstra Piet W
Thoraxcentre of the Groningen University Hospital, Groningen, The Netherlands.
J Am Coll Cardiol. 2002 Dec 4;40(11):1955-60. doi: 10.1016/s0735-1097(02)02536-6.
This study was done to identify the best treatment for an isolated high-grade stenosis of the proximal left anterior descending coronary artery (LAD).
Percutaneous transluminal coronary angioplasty with stenting (PCI) and off-pump coronary artery bypass grafting (surgery) are used to treat single-vessel disease of a high-grade stenosis of the proximal LAD. Midterm results of both treatments are compared in this prospective randomized study.
In a single-center prospective trial, we randomly assigned 102 patients with a high-grade stenosis of the proximal LAD (American College of Cardiology/American Heart Association classification type B2 or C) to PCI (n = 51) or surgery (n = 51). Primary composite end point was freedom from Major Adverse Cardiac and Cerebrovascular Events (MACCE) at follow-up, including death, myocardial infarction, cerebrovascular accident, and repeat target vessel revascularization (TVR). Secondary end points were angina pectoris class and need for antianginal medication at follow-up. Analysis was by intention-to-treat (ITT) and received treatment (RT).
Mean follow-up time was three years (90% midrange, two to four years). Incidence of MACCE was 23.5% after PCI and 9.8% after surgery; p = 0.07 ITT (24.1% vs. 8.3%; p = 0.04 RT). After surgery a significantly lower angina pectoris class (p = 0.02) and need for antianginal medication (p = 0.01) was found compared to PCI. Target vessel revascularization was 15.7% after PCI and 4.1% after surgery (p = 0.09).
At three-year follow-up (range, two to four years), a trend in favor of surgery is observed in regard to MACCE-free survival with a significantly lower angina pectoris status and significantly lower need for antianginal medication.
本研究旨在确定治疗孤立性左前降支冠状动脉（LAD）近端高度狭窄的最佳方法。
经皮冠状动脉腔内血管成形术加支架置入术（PCI）和非体外循环冠状动脉搭桥术（手术）用于治疗LAD近端高度狭窄的单支血管病变。在这项前瞻性随机研究中，对两种治疗方法的中期结果进行了比较。
在一项单中心前瞻性试验中，我们将102例LAD近端高度狭窄（美国心脏病学会/美国心脏协会分类为B2型或C型）的患者随机分为PCI组（n = 51）或手术组（n = 51）。主要复合终点是随访时无主要不良心脑血管事件（MACCE），包括死亡、心肌梗死、脑血管意外和再次靶血管血运重建（TVR）。次要终点是随访时的心绞痛分级和抗心绞痛药物需求。分析采用意向性治疗（ITT）和接受治疗（RT）。
平均随访时间为三年（90%的范围为两年至四年）。PCI术后MACCE发生率为23.5%，手术组为9.8%；ITT分析p = 0.07（24.1%对8.3%；p = 0.04，RT分析）。与PCI相比，手术后心绞痛分级明显更低（p = 0.02），抗心绞痛药物需求明显更低（p = 0.01）。PCI术后靶血管血运重建率为15.7%，手术组为4.1%（p = 0.09）。
在三年随访期（范围为两年至四年），在无MACCE生存方面观察到倾向于手术治疗的趋势，心绞痛状况明显更低，抗心绞痛药物需求明显更低。
