MIDCAB Versus DES in Proximal LAD Lesions

Inclusion criteria

• Single-vessel disease of the proximal LAD with a stenosis > 50% (multivessel disease only if further coronary vessel stenoses do not require treatment)
• Patients with angina pectoris (CCS 1-4)
• Asymptomatic patients if clear signs of ischemia in the segments supplied by the LAD as assessed by bicycle ergometry or treadmill and/or scintigraphically and/or stress echo
• Patients for whom both methods of treatment are equally possible
• Consensus between the cardiac surgeon and the cardiologist that both inclusion and exclusion criteria are met in the selected case
• Informed consent of the patient.

Exclusion criteria

• Patients < 18 years
• Pregnancy
• Previous coronary artery bypass surgery
• Concomitant diseases that lead to a greater risk for each of the treatment strategies
• Significant peripheral arterial occlusive disease
• Concomitant disease with limited life expectancy (e.g. malignant tumours that have not been curatively treated)
• Objective follow-up examination not possible due to physical or mental handicap
• Participation in another study.

Angiographical exclusion criteria:

• Left main stem stenosis
• Multivessel disease for which surgical or interventional therapy on other vessel areas is required.
• Diagonal/septal branch > 1.5 mm, which might be compromised by a stent
• Need for acute intervention (e.g. acute myocardial infarction)
• Total occlusion of the LAD