Comparison of medicine alone, coronary angioplasty, and left internal mammary artery–coronary artery bypass for one-vessel proximal left anterior descending coronary artery disease
Section snippets
Patients
Between April 1, 1986, and February 28, 1994, 1,218 patients with proximal LAD disease undergoing a first diagnostic angiogram were identified. Of these, 754 underwent angioplasty, 149 underwent LIMA bypass (another 21 had vein grafts, which were excluded from analysis), and the remainder (n = 294) underwent no procedures within the first 30 days after angiography. These 1,197 eligible patients had coronary syndromes ranging from stable angina to evolving AMI, and reflected left ventricular
Results
Fewer women underwent surgery than did those taking other treatments (Table 1). Patients who had undergone angioplasty or LIMA grafting more often had either progressive or unstable angina than did medically treated patients. Risk factor profiles were similar except for more diabetics in the medical and angioplasty groups. The greatest differences among the groups occurred in clinical measures of myocardial damage. On average, medically treated patients had a longer duration of symptoms, more
Discussion
In this observational comparison of patients with 1-vessel, proximal LAD disease, surgical and percutaneous revascularizations were associated with nonsignificant survival advantages compared with medical therapy after adjustment for baseline clinical and angiographic differences. Further, LIMA bypass (but not angioplasty) was associated with a significant, long-term reduction in a composite of adverse cardiac events, largely driven by fewer repeat interventions. Angioplasty resulted in
Acknowledgements
We thank Pat French and A. J. Mayhew for editorial assistance, and Anthony Doll for graphic assistance.
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