Objectives The purpose of this randomized study was to compare sirolimus-eluting stenting (SES) with minimally invasive direct

Background Bare-metal stenting is inferior to MIDCAB surgery in patients with isolated proximal LAD lesions due to a higher

Methods A total of 130 patients with significant proximal LAD coronary artery disease were randomized to either SES (n
65) or

MIDCAB surgery (n
65). The primary clinical end point was noninferiority in freedom from major adverse cardiac events

Results Follow-up was completed for all patients. MACE occurred in 7.7% of patients after stenting, as compared with 7.7%

after surgery (p
0.03 for noninferiority). The individual components of the combined end point revealed mixed results.

p 0.001), noninferiority was not established for the difference in target vessel revascularization (6.2% vs.

0%, noninferiority p
0.21). Clinical symptoms improved significantly in both treatment groups in comparison with

baseline, and the percentage of patients free from angina after 12 months was 81% versus 74% (p
0.49).

Conclusions In isolated proximal LAD disease, SES is noninferior to MIDCAB surgery at 12-month follow-up with respect to MACE