Minimally invasive bypass surgery was better than stenting for a high-grade proximal left anterior descending (LAD) coronary artery stenosis, according to the results of a randomized trial reported in the Aug. 22 issue of the New England Journal of Medicine.
“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,” write Anno Diegeler, MD, and colleagues from the University of Leipzig in Germany.
Among 220 symptomatic patients with high-grade proximal LAD stenosis, 31% of those randomized to stenting and 15% of those randomized to surgery had a major adverse cardiac event, defined as cardiac death, myocardial infarction, or the need for revascularization within six months (P=.02). This difference was mostly related to higher rate of revascularization after stenting (29% vs. 8%; P=.003). At six-month follow-up, 79% of patients in the surgery group and 62% of patients in the stenting group were free from angina (P=.03).
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