Minimally Invasive Direct Coronary Artery Bypass Versus Percutaneous Coronary Intervention for Isolated Left Anterior Descending Artery Stenosis: An Updated Meta-Analysis
DOI:
https://doi.org/10.1532/hsf.5211Keywords:
minimally invasive direct coronary artery bypass, percutaneous coronary intervention, target vessel revascularization, major adverse cardiovascular events (MACE)Abstract
Background: The optimal revascularization strategy for isolated left anterior descending (LAD) coronary artery lesion between minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) remains controversial. This updated meta-analysis aims to compare the long- and short-term outcomes of MIDCAB versus PCI for patients with isolated LAD coronary artery lesions.
Methods: The Pubmed, Web of Science, and Cochrane databases were searched for retrieving potential publications from 2002 to 2022. The primary outcome was long-term survival. Secondary outcomes were long-term target vessel revascularization (TVR), long-term major adverse cardiovascular events (MACEs), and short-term outcomes, including postoperative mortality, myocardial infarction (MI), TVR, and MACEs of any cause in-hospital or 30 days after the revascularization.
Results: Six randomized controlled trials (RCTs) and eight observational studies were included in this updated meta-analysis. In total, 1757 patients underwent MIDCAB and 15245 patients underwent PCI. No statistically significant difference was found between the two groups in the rates of long-term survival. MIDCAB had a lower long-term MACE rate compared with PCI. Besides, PCI resulted in an augmented risk of TVR. Postoperative mortality, MI, TVR, and MACEs were similar between the two groups.
Conclusions: The updated meta-analysis presents the evidence that MIDCAB has a reduced risk of long-term TVR and MACEs, with no benefit in terms of long-term mortality and short-term results, in comparison with PCI. Large multicenter RCTs, including patients treated with newer techniques, are warranted in the future.
References
Benedetto U, Raja SG, Soliman RF, Albanese A, Jothidasan A, Ilsley CD, et al. 2014. Minimally invasive direct coronary artery bypass improves late survival compared with drug-eluting stents in isolated proximal left anterior descending artery disease: a 10-year follow-up, single-center, propensity score analysis. J Thorac Cardiovasc Surg. 148(4):1316-22.
Bhatt DL. 2018. Percutaneous Coronary Intervention in 2018. JAMA. 319(20):2127-2128.
Blazek S, Holzhey D, Jungert C, Borger MA, Fuernau G, Desch S, et al. 2013. Comparison of bare-metal stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 10-year follow-up of a randomized trial. JACC Cardiovasc Interv. 6(1):20-6.
Blazek S, Rossbach C, Borger MA, Fuernau G, Desch S, Eitel I, et al. 2015. Comparison of sirolimus-eluting stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 7-year follow-up of a randomized trial. JACC Cardiovasc Interv. 8(1 Pt A):30-8.
Cisowski M, Drzewiecki J, Drzewiecka-Gerber A, Jaklik A, Kruczak W, Szczeklik M, et al. 2002. Primary stenting versus MIDCAB: preliminary report-comparision of two methods of revascularization in single left anterior descending coronary artery stenosis. Ann Thorac Surg. 74(4):S1334-9.
Deppe AC, Liakopoulos OJ, Kuhn EW, Slottosch I, Scherner M, Choi YH, et al. 2015. Minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for single-vessel disease: a meta-analysis of 2885 patients. Eur J Cardiothorac Surg. 47(3):397-406; discussion 406.
Drenth DJ, Veeger NJ, Middel B, Zijlstra F, Boonstra PW. 2004. Comparison of late (four years) functional health status between percutaneous transluminal angioplasty intervention and off-pump left internal mammary artery bypass grafting for isolated high-grade narrowing of the proximal left anterior descending coronary artery. Am J Cardiol. 94(11):1414-7.
Etienne PY, D'Hoore W, Papadatos S, Mairy Y, El Khoury G, Noirhomme P, et al. 2013. Five-year follow-up of drug-eluting stents implantation vs minimally invasive direct coronary artery bypass for left anterior descending artery disease: a propensity score analysis. Eur J Cardiothorac Surg. 44(5):884-90.
Fitchett DH, Gupta M, Farkouh ME, Verma S. 2014. Cardiology Patient Page: coronary artery revascularization in patients with diabetes mellitus. Circulation. 130(12):e104-6.
Hannan EL, Zhong Y, Cozzens K, Adams DH, Girardi L, Chikwe J, et al. 2021. Revascularization for Isolated Proximal Left Anterior Descending Artery Disease. Ann Thorac Surg. 112(2):555-562.
Hong SJ, Lim DS, Seo HS, Kim YH, Shim WJ, Park CG, et al. 2005. Percutaneous coronary intervention with drug-eluting stent implantation vs. minimally invasive direct coronary artery bypass (MIDCAB) in patients with left anterior descending coronary artery stenosis. Catheter Cardiovasc Interv. 64(1):75-81.
Iakovou I, Dangas G, Mehran R, Lansky AJ, Stamou SC, Pfister AJ, et al. 2002. Minimally invasive direct coronary artery bypass (MIDCAB) versus coronary artery stenting for elective revascularization of the left anterior descending artery. Am J Cardiol. 90(8):885-7.
Kandaswamy E, Zuo L. 2018. Recent Advances in Treatment of Coronary Artery Disease: Role of Science and Technology. Int J Mol Sci. 19(2).
Kim JW, Lim DS, Sun K, Shim WJ, Rho YM. 2005. Stenting or MIDCAB using ministernotomy for revascularization of proximal left anterior descending artery? Int J Cardiol. 99(3):437-41.
Li S, Zhang H, Xiao C, Wang R, Wu Y. 2021. Robotically assisted coronary artery bypass graft surgery versus drug-eluting stents for patients with stable isolated proximal left anterior descending disease. J Card Surg. 36(6):1864-1871.
Lo CK, Mertz D, Loeb M. 2014. Newcastle-Ottawa Scale: comparing reviewers' to authors' assessments. BMC Med Res Methodol. 14:45.
Mastroiacovo G, Manganiello S, Pirola S, Tedesco C, Cavallotti L, Antona C, et al. 2021. Very Long-term Outcome of Minimally Invasive Direct Coronary Artery Bypass. Ann Thorac Surg. 111(3):845-852.
Mehran R, Dangas G, Stamou SC, Pfister AJ, Dullum MK, Leon MB, et al. 2000. One-year clinical outcome after minimally invasive direct coronary artery bypass. Circulation. 102(23):2799-802.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. 2021. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 372:n71.
Patel NC, Hemli JM, Seetharam K, Singh VP, Scheinerman SJ, Pirelli L, et al. 2022. Minimally invasive coronary bypass versus percutaneous coronary intervention for isolated complex stenosis of the left anterior descending coronary artery. J Thorac Cardiovasc Surg. 163(5):1839-1846.e1.
Raja SG, Uzzaman M, Garg S, Santhirakumaran G, Lee M, Soni MK, et al. 2018. Comparison of minimally invasive direct coronary artery bypass and drug-eluting stents for management of isolated left anterior descending artery disease: a systematic review and meta-analysis of 7,710 patients. Ann Cardiothorac Surg. 7(5):567-576.
Reeves BC, Angelini GD, Bryan AJ, Taylor FC, Cripps T, Spyt TJ, et al. 2004. A multi-centre randomised controlled trial of minimally invasive direct coronary bypass grafting versus percutaneous transluminal coronary angioplasty with stenting for proximal stenosis of the left anterior descending coronary artery. Health Technol Assess. 8(16):1-43.
Seo DH, Kim JS, Park KH, Lim C, Chung SR, Kim DJ. 2018. Mid-Term Results of Minimally Invasive Direct Coronary Artery Bypass Grafting. Korean J Thorac Cardiovasc Surg. 51(1):8-14.
Shirai K, Lansky AJ, Mehran R, Dangas GD, Costantini CO, Fahy M, et al. 2004. Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease. Am J Cardiol. 93(8):959-62.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. 2019. RoB 2: a revised tool for assessing risk of bias in randomised trials. Bmj. 366:l4898.
Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. 2007. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 8:16.
Wang XW, Qu C, Huang C, Xiang XY, Lu ZQ. 2016. Minimally invasive direct coronary bypass compared with percutaneous coronary intervention for left anterior descending artery disease: a meta-analysis. J Cardiothorac Surg. 11(1):125.
