Comparison of Minimally Invasive Direct Coronary Artery Bypass and Percutaneous Coronary Intervention Using Second-Generation Drug-Eluting Stents for Coronary Artery Disease　― Propensity Score-Matched Analysis ―

Abstract

wound infections, fewer transfusions, and shorter incision length. 1-3 In addition to these advantages, MIDCAB is a reasonable treatment option for proximal left anterior descending artery (LAD) stenosis, especially in patients who are not suitable candidates for percutaneous coronary intervention (PCI). 4 M inimally invasive direct coronary artery bypass (MIDCAB) is a method of coronary artery bypass graft (CABG) surgery that is performed without a median sternotomy. It has similar clinical outcomes but many advantages over conventional CABG, including shorter intensive care unit (ICU) stay, fewer

Alternative Approaches to Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention, How Do They Compare?: A Systematic Review and Meta-Analysis

“…The benefits of traditional CABG include more complete revascularization, improved long-term survival, freedom from anginal symptoms, protection against future ischemia, and freedom from repeat revascularization. 3,4,8,10,17,18,22,26,43,48 ACABG reduces the invasiveness of CABG while still allowing for the same quality of revascularization. The use of the IMA to graft LAD lesions has been a main contributor resulting in improved long-term outcomes of CABG patients.…”

“…Postprocedural stroke occurred in 0.0% to 6.48% of ACABG patients and 0.0% to 7.41% of PCI patients with 1 study identifying lower rates of stroke in PCI patients compared with OPCAB (P < 0.0001). 26,42,[44][45][46][47] Pooled rates of stroke did not vary significantly with OR of 0.95 (95% CI, 0.33-2.70; P = 0.92) (Figure 3B). There was considerable heterogeneity between the included studies (Tau 2 = 1.12, Chi 2 = 66.95, I 2 = 94%, P < 0.00001) (Figure 3B).…”

“…Four studies were included comparing rates of required revascularization after MIDCAB versus PCI with results favoring MIDCAB with OR of 0.17 (95% CI, 0.07-0.38; P < 0.0001) (Figure 2C). 26,39,40,42 Heterogeneity between the included studies was insignificant (Chi 2 = 2.43, I 2 = 0%, P = 0.49) (Figure 2C).…”

“…The studies by Blazek, Barsoum, Choi, and Merkle, compared MIDCAB with PCI. 26,[39][40][41] Li, Patel, Su (2018), and Su (2019), compared roboticassisted MIDCAB with PCI. 17,[42][43][44] While Lee, Moreyra, and Yin investigated outcomes following OPCAB and PCI.…”

“…Eight studies demonstrated significantly higher rates of required repeat revascularization in PCI patients compared to ACABG patients (P = 0.014-<0.0001). 17,26,[39][40][41][42][43][44][45][46][47] Pooled estimates of repeat revascularization rates favored ACABG with OR of 0.25 (95% CI, 0.15-0.39; P < 0.00001) (Figure 3C). Moderate heterogeneity was identified between the FIGURE 1.…”