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Randomized comparison of minimally invasive direct coronary artery bypass surgery versus sirolimus-eluting stenting in isolated proximal left anterior descending coronary artery stenosis
JACC - Journal of the American College of Cardiology, 06/18/09

Thiele H et al. – In isolated proximal left anterior descending (LAD) disease, sirolimus-eluting stenting (SES) is noninferior to minimally invasive direct coronary artery bypass (MIDCAB) surgery at 12-mo follow-up with respect to major adverse cardiac events (MACE) at a similar relief in clinical symptoms.

Methods

Randomized study comparing SES with MIDCAB surgery for pts with isolated proximal LAD coronary artery disease
Randomization of 130 pts with significant proximal LAD coronary artery disease to either SES (65 pts) or MIDCAB surgery (65)
Primary clinical endpoint: noninferiority in freedom from MACE, such as cardiac death, myocardial infarction, and the need for target vessel revascularization within 12 mo

Results

Follow-up completed for all pts
MACE in 7.7% of pts after stenting vs 7.7% after surgery
Individual components of combined endpoint yielded mixed results
Although noninferiority shown for difference in death and myocardial infarction (1.5% vs 7.7%), noninferiority not established for difference in target vessel revascularization (6.2% vs 0%)
Clinical symptoms improved significantly in both treatment groups vs baseline
Percentage of pts free from angina after 12 mo: 81% vs 74%