Drenth, Derk Jan

English

This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis of the proximal left anterior descending coronary artery ... Zie: Summar

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   University of GroningenOff-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplastywith stenting for proximal left anterior descending coronary artery disease?Drenth, Derk JanIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2005Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Drenth, D. J. (2005). Off-pump coronary artery bypass grafting or percutaneous transluminal coronaryangioplasty with stenting for proximal left anterior descending coronary artery disease?. s.n.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 06-06-2022SummaryThis thesis describes and discusses the results of a prospective randomized controlledclinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and ofÊpump coronary artery bypass grafting with a left internal mammary artery (surgery) inpatients with a high-grade stenosis of the proximal left anterior descending coro nary artery.Chapter IThis chapter contains the General Introduction and the aims of this thesis. patients wereincluded between March 1997 and, September 1999 and were randomized to stenting (n:51)or to surgery (n:5 I ). Details of clinical outcome are described in the chapters l -4.Chapter 2Surgery resulted in a better angiographic outcome than stenting at 6-month follow-up. Astenosis rcte of 4Yo was found in the anastomoses after surgery, while a restenosis rate of29oÁ was found after stenting. However, clinical outcome did not differ between bothtreatment groups at 6-month follow-up.Chapter 3At 3-year follow-up (range 2-4 years), a statistically non-significant difference betweenboth treatments was observed regarding freedom from Major Adverse Cardiac orCerebrovascular events (MACCE). Incidence of MACCE was 23.s%after stenting and g.g%after surgery (p:0.07). However, surgically treated patients had a significantly lower anginaclass and a significantly lower need for anti-anginal medication compared to stented patients.Chapter 4At 4-year follow-up (range 3-5 years), the trend of a lower MACCE rate after surgerycompared to stenting became statistically significant. MACCE occurre d in 27 .S%oof patientsafter stenting and in 9.8oÁ of patients after surgery fu:0.02). In addition, Íieedom fromangina pectoris was 67Yo after stenting and g5% after surgery fu:0.04). Furthermore, theneed for anti-anginal medication remained statistically lower after surgery compared tostenting (p:0.002).Stt nt ntctt '1,Chctpler 5I 'aral lc l  to c l in ical  f i r l lorv-up as c lescr ibcd in chal ' r tcr  -1,  thc l i rnct ional  hcal th status ( l ' ' l lS)r . r Í 'our study populat ion \ \ 'AS assessecl  u ' i th thc gcncr ic Short-Fornt-36 (SF-3(r)  ancl  thephys ica l  c lo rna in  o1 ' thc  d iscasc  spcc i l i c  l v l inncsota  L iv ing  u i th  I I car t  l -a i lu rc  Qucs t ionnu i lc(MLI IFQ) .T l tc  asscsscc l  F I IS  d id  no t  c l r l ' Í c r  be tuecn surgcry  and s tcn t ing .  G loba l  qLres t ionsshou,cd that thc nra. jor i ty ol 'pat icnts pcrccivccl  an inrprovenrent in thcir  physical  status s inccstcnt ing or sLrrgcry.  I )at icnts u, i thout a MACCII  hacl  a bct tcr  FI IS than pat ients n ' i th aMACCI' .  dur ing Íb l lou'-Lrp.  Thc l - l lS status oÍ- thc u 'holc stLrdy populat ion appcarccl  to [ rccc lua l  to  the  I r l lS  o l 'a  hca l th l , rc fc rcncc  popLr la t ion .  I l cc r rusc  s tcn t ing  i t s  r i c l l  l i s  sL l rgcrvrcsr. t l tcd in thc sanrc I - - l lS,  but  in a s igni l icant ly c l i f lcrcnt  f l 'ccdonr l ionr lvÍACCE, at . l -y 'carÍ i t l lor i ' -up,  l i l lS-asscssrnent cannot bc usccl  to aic l  dccis ion-rnaking Lrclvn'ccr-r  stcnt ing anclsurgcry l i r r  the typc oí 'pat icnt  cr t ro l lcc l  in our t r ia l .Cl tuptar 6This chaptcr is a rc l ' icrv ol 'a l l  rcccnt nrrr jor 'prospcct ivc randomiz.ccl  control lcd t r ia ls,cotnl l t r i t tg stcnt ing atrc l  surgery in s ingle vessel  LAI)  d iscasc as rvcl l  as in mult i 'n,csscldiscasc. I t  a lso prescnts l i r ture perspect ivcs and i t  d iscusses sontc l tcrv developmcnts uch asthosc regarding clrLrg elLrt ing stcnt  tcchnology..!jCltoplct' 7This chaptcr contains thcthc Íicld of curonary i irtcrypubl ished cl iscussions \ \ 'c  hacl  u ' i th othcr c l in ical  rcscarchcrs incl iscasc ancl  rcvascul i i r izat ion.Cltapler 8Conta ins the sun. rn tary  o l ' th is  thcs is .

Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

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Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

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