Comparison of balloon angioplasty , stent insertion and medical therapy in the treatment of single LAD lesion

Cho, Seung Yun; Jang, Yang Soo; Lee, Dong Il; Pyun, Wook Bum; Choi, Dong Hoon; Shim, Won Heum

Abstract

With recent advances in transarterial interventional technique, there is a tendency to treat single LAD lesion with balloon angioplasty or stent insertion rather than with medical therapy alone. Therefore, it is important to evaluate the long-term clinical outcomes of such interventional therapy.
METHODS
Subjects are comprised of patients who underwent coronary angiogram from 1993 to 1996 and diagnosed as having single LAD lesion without decrease of left ventricular fuction. The incidence of major ischemic complications, revascularization and reduction of angina pectoris after different therapeutic strategies in these patients are evaluated. RESULT: 1) There was total of 190 patients. Patients receiving medical therapy, balloon angioplasty and stent insertion were 70, 75, and 45 respectively. There was no significant difference in mean age, sex ratio, and risk factors of coronary artery occlusive disease between each groups. 2) The medical therapy group(30%) had a significantly lower incidence of proximal stenosis lesion compared to the balloon angioplasty group (45%) and stent insertion group(52%) according to the location of the lesion(p<0.05). The lesion characteristics according to the AHA/ACC criteria showed that the proportion of type A lesion was significantly higher in the balloon angioplasty group(33.3%) compared to the medical therapy group(8.6%) and stent insertion group(13.3%), whereas the proportion of type C lesion was significantly higher in the medical therapy group(41.4%) compared to the balloon angioplasty group(14.3%) and stent insertion group(22.2%). 3) The incidence of ischemic complication were low with 9 out of total 190 patients during follow up consisting of 2 cases of cardiogenic death(1.1%) and 7 cases of acute myocardial infarction(3.7%). 4) During the follow-up period revascularization was performed in 10% of medical therapy group, 27% of balloon angioplasty group and 22% of stent insertion group. There was higher rate of revascularization in patients who received interventional therapy. 5) During the mean follow-up period of 38 months, event-free survival rate was 85% in the patient group receiving medical therapy, 71% in the patient group undergoing balloon angioplasty and 74% in the patient group undergoing stent insertion. There was lower incidence of major events in medical therapy patients, but the difference of the rate among each group was not significant. In considering the patients with proximal LAD stenotic lesion, event-free survival rate was 73% in medical therapy group, 75% in balloon angioplasty group and 81% in stent insertion group, but the difference between each groups did not show any significant difference. 6) Follow-up of each study groups at 6 months, 1 year and 3 years showed that the proportion of chest pain-free patients in balloon angioplasty and stent insertion group were higher than those in medical therapy group despite the lack of statistical significance(p>0.05). CONCLUSION: For patients with single LAD stenotic lesion interventional therapies such as balloon angioplasty and stent insertion might be more effective without statistical signigicance in reducing chest pain compared to medical therapy. There was no significant difference in the incidence of ischemic complication and rate of revascularization among different study groups. Further studies will be needed to clarify the beneficial effects of interventional coronary artery therapy such as improvement of chest pain, increased exercise capacity, and improved quality of life along with other parameters.