Mortality and myocardial infarction following surgical versus percutaneous revascularization of isolated left anterior descending artery disease: a meta-analysis.
OBJECTIVE
Despite numerous studies comparing surgical versus percutaneous revascularization, the optimal treatment of patients with isolated left anterior descending (LAD) artery disease remains debated. We conducted a meta-analysis to study the early and mid-term outcomes following percutaneous and surgical treatment of isolated LAD disease.


METHODS
Medline, EMBASE, and the Cochrane databases were searched and a hand search of bibliographies was conducted. Clinical data was extracted independently by two individuals. Random effects models were used to calculate pooled risk ratios (RR) and meta-regression was employed to explain study heterogeneity. Stratified analyses were conducted and a Funnel plot was used to assess publication bias.


RESULTS
Eight randomized trials (1110 patients; median follow-up: 2.1 years, range: 0.5-5 years) and nine observational studies (12,209 patients; median follow-up: 3 years, range: 0.5-5.5 years) were identified and analyzed separately. Both randomized and observational studies demonstrated a beneficial effect of surgery compared to percutaneous therapy on mid-term major adverse cardiac events (MACE) (RR [95% CI]: 0.33 [0.24-0.46] for randomized and 0.32 [0.24-0.41] for observational studies). Studies with >1 year of follow-up demonstrated a beneficial effect of surgery compared to percutaneous therapy on combined mortality and MI rates for randomized (RR [95% CI]: 0.59 [0.35-0.98]) and observational studies (RR [95% CI]: 0.81 [0.65-0.99]). The start year was identified as a source of study heterogeneity.


CONCLUSIONS
Surgical treatment of isolated LAD disease is associated with reduced MACE, reduced mortality, and MI rates at mid-term follow-up, as well as lower recurrence of angina. Evolution of treatment strategies may explain some of the variability between studies.
Boodhwani
Munir
M
Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA.
Rubens
Fraser D
FD
Sellke
Frank W
FW
Mesana
Thierry G
TG
Ruel
Marc
M
D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D023921:Coronary Stenosis / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009203:Myocardial Infarction / Q000209:etiology*; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D012107:Research Design; D012307:Risk Factors; D016896:Treatment Outcome