Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery.
OBJECTIVE
To compare outcomes between minimally invasive left internal thoracic artery bypass and percutaneous coronary artery stenting as primary interventions for isolated lesions of the left anterior descending artery.


METHODS
Meta-analysis of randomised and non-randomised comparative peer reviewed publications.


METHODS
Embase, Medline, Cochrane, Google Scholar, and Health Technology Assessment databases (1966-2005).


METHODS
Studies comparing the two procedures as the primary intervention for isolated left anterior descending artery stenosis were identified and the following extracted: study design, population characteristics, severity of coronary artery disease, cardiovascular risk factors, and outcomes of interest.


RESULTS
12 studies (1952 patients) reporting results from eight groups were included: one was a retrospective design, one prospective non-randomised, and six prospective randomised. Meta-analysis of randomised trials showed a higher rate of recurrence of angina (odds ratio 2.62, 95% confidence interval 1.32 to 5.21), incidence of major adverse coronary and cerebral events (2.86, 1.62 to 5.08), and need for repeat revascularisation (4.63, 2.52 to 8.51) with percutaneous stenting. No significant difference was found in myocardial infarction, stroke, or mortality at maximum follow-up between interventions.


CONCLUSIONS
Minimally invasive left internal thoracic artery bypass for isolated lesions of the left anterior descending artery resulted in fewer complications in the mid-term compared with percutaneous transluminal coronary artery stenting.
Aziz
Omer
O
Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London W2 1NY.
Rao
Christopher
C
Panesar
Sukhmeet Singh
SS
Jones
Catherine
C
Morris
Stephen
S
Darzi
Ara
A
Athanasiou
Thanos
T
D000787:Angina Pectoris / Q000601:surgery; D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015607:Stents; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome