Minimally invasive direct coronary bypass compared with percutaneous coronary intervention for left anterior descending
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RESEARCH ARTICLE
Open Access
Minimally invasive direct coronary bypass compared with percutaneous coronary intervention for left anterior descending artery disease: a meta-analysis Xiao-Wen Wang1,2†, Can Qu3†, Chun Huang1*, Xiao-Yong Xiang1 and Zhi-Qian Lu2
Abstract Background: The clinical outcomes for left anterior descending (LAD) coronary artery lesion between minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) are still controversial. The objective was to compare safety and efficacy between MIDCAB and PCI for LAD. Methods: Electronic databases and article references were systematically searched to access relevant studies. End points included mortality, myocardial infarction, target vessel revascularization (TVR), major adverse coronary events (MACE), angina recurrence, and stroke. Results: Fourteen studies with 941 patients were finally involved in the present study. The mortality and incidence of myocardial infarction were similar in MIDCAB and PCI groups at 30 days, 6 months, and at follow-up beyond 1 year. Compared with PCI, MIDCAB decreased incidence of TVR and MACE at 6 months and beyond 1 year follow-up. MIDCAB was associated with a lower incidence of angina recurrence at 6 months compared with PCI. PCI was associated with higher risk of restenosis in target vessel. No significant difference was shown for stroke. Conclusion: Our meta-analysis indicates that there are no significant differences in the safety between MIDCAB and PCI in patients with LAD. However MIDCAB is superior to PCI for TVR and MACE. Keywords: Left anterior descending coronary artery, Minimally invasive direct coronary artery bypass, Percutaneous coronary intervention, Outcome
Background Minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) are alternative procedures to mechanical revascularization for patients with left anterior descending (LAD) coronary artery lesion. The effects of these two procedures on cardiovascular outcomes have been compared in several clinical trials. Further, the comparative effectiveness of MIDCAB and PCI remains poorly understood for patients in whom both procedures are technically feasible and coronary revascularization is clinically indicated. * Correspondence: [email protected] † Equal contributors 1 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People’s Republic of China Full list of author information is available at the end of the article
Since the publication of those meta-analyses, additional trials and long term results have become available Metaanalyses of individual patient data from clinical controlled trials substantially have the potential to increase the power and improve the precision of treatment effects and safety. Thus, the goal of this study was to perform a meta-analysis of trials to evaluate the comparative effectiveness of MIDCAB and PCI among patients with isolated lesions of the LAD.
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