Comparison of medicine alone, coronary angioplasty, and left internal mammary artery–coronary artery bypass for one-vessel proximal left anterior descending coronary artery disease

• Published in: The American journal of cardiology 2000-12, Vol.86 (12), p.1322-1326
• Main Authors: Greenbaum, Adam B, Califf, Robert M, Jones, Robert H, Gardner, Laura H, Phillips, Harry R, Sketch, Michael H, Stack, Richard S, Puma, Joseph A
• Format: Article
• Language: English
• Subjects: Aged; Angina, Unstable - drug therapy; Angina, Unstable - surgery; Angina, Unstable - therapy; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiac Output, Low - etiology; Cardiology; Cardiovascular Agents - therapeutic use; Cardiovascular disease; Cohort Studies; Comparative studies; Confidence Intervals; Coronary Disease - drug therapy; Coronary Disease - surgery; Coronary Disease - therapy; Disease Progression; Drug therapy; Female; Follow-Up Studies; Humans; Incidence; Internal Mammary-Coronary Artery Anastomosis; Male; Medical sciences; Middle Aged; Myocardial Infarction - etiology; Odds Ratio; Proportional Hazards Models; Prospective Studies; Reoperation; Retreatment; Retrospective Studies; Sex Factors; Stroke Volume; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(00)01235-2

Despite the deleterious and sometimes catastrophic consequences of proximal left anterior descending (LAD) artery occlusion, there is a paucity of data to guide the treatment of patients with such disease. Our aim was to describe outcomes with medical therapy, angioplasty, or left internal mammary artery (LIMA) bypass grafting in patients with 1-vessel, proximal LAD disease. We retrospectively analyzed prospectively collected data from 1,188 patients first presenting only with proximal LAD disease at 1 center over 9 years. We assessed the rates of death, acute myocardial infarction, and repeat intervention by initial treatment over a median 5.7 years of follow-up. Patients undergoing angioplasty or LIMA bypass were more often men and had progressive or unstable angina; those receiving medical therapy had a lower median ejection fraction. Both revascularization procedures offered slightly better adjusted survival versus medicine (hazard ratio for angioplasty, 0.82; 95% confidence interval, 0.60 to 1.11; hazard ratio for bypass, 0.74; 95% confidence interval, 0.44 to 1.23). Bypass, but not angioplasty, was associated with significantly fewer composite end point events (death, infarction, or reintervention, p