Background Randomized studies have shown that the use of coronary-arterystenting as the initial treatment for coronary stenosis is associatedwith a lower risk of restenosis than is standard coronary angioplasty.We prospectively investigated the efficacy of these two approachesin selected patients with isolated stenosis of the proximalleft anterior descending coronary artery.
Methods A total of 120 patients with isolated stenosis of theproximal left anterior descending coronary artery were randomlyassigned to stent implantation or standard coronary angioplasty.The primary clinical end points were the rate of proceduralsuccess (defined as residual stenosis of less than 50 percentand the absence of death, myocardial infarction, and the needfor coronary-artery bypass surgery during the hospital stay)and the rate of event-free survival (defined as freedom fromdeath, myocardial infarction, and the recurrence of angina)at 12 months. The angiographic end point was the rate of restenosis12 months after the procedure.
Results The two treatment groups did not differ significantlywith respect to demographic, clinical, or angiographic characteristics.The rates of procedural success were similar in the two groupsof patients (95 percent in the stenting group vs. 93 percentin the angioplasty group, P = 0.98). The 12-month rates of event-freesurvival were 87 percent after stenting and 70 percent afterangioplasty (P = 0.04). The rates of restenosis were 19 percentafter stent implantation and 40 percent after angioplasty (P= 0.02).
Conclusions In patients with symptomatic isolated stenosis ofthe proximal left anterior descending coronary artery, stentinghad advantages over standard coronary angioplasty in that itwas associated with both a lower rate of restenosis and a betterclinical outcome.
Source Information
From the Servizio Speciale di Diagnosi e Cura di Emodinamica, Divisione di Cardiochirurgia, Università di Roma Tor Vergata (F.V., A.G., F.T., L.C., P.A.G.); and the Istituto di Cardiologia, Università Cattolica del Sacro Cuore (F.C.) — both in Rome.
Address reprint requests to Professor Gioffrè at the Servizio Speciale di Diagnosi e Cura di Emodinamica, Divisione di Cardiochirurgia, Università di Roma Tor Vergata, via Portuense 700, 00149 Rome, Italy.
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