Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery: Six months' angiographic and clinical follow-up of a prospective randomized study

Drenth, Derk J; Winter, Jobst B.; Veeger, Nic J. G. M.; Monnink, Shj; Boven, Ad J. van; Grandjean, Jan G.; Mariani, Massimo A.; Boonstra, Piet W.

doi:10.1067/mtc.2002.122525

Cited by 50 publications

(27 citation statements)

References 18 publications

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“…The discussion about potential shortcomings of CABG as compared to PCI was fueled after the first large industry‐funded trial3 found significantly higher rates of major adverse cardiac and cerebrovascular events in the PCI group (17.8% versus 12.4% for CABG; P =0.002), in large part because of an increased rate of repeat revascularization (13.5% versus 5.9%); however, at 12 months, strokes were 4‐fold more likely to occur with CABG (2.2% versus 0.6% with PCI; P =0.003). None of the following studies comparing PCI with OPCAB38, 39, 40, 41 were powered for stroke, and none reports the extent of “no‐touch” technique in the CABG group. Conversely, one recent trial assessing midterm outcomes of 438 patients randomly assigned to the PCI with everolimus eluting stents and 442 randomly assigned to the CABG group42 found no difference in the risk of stroke between the 2 groups: hazard ratio 0.86 (0.39–1.93); P =0.72.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Pawliszak

Kowalewski

Raffa

et al. 2016

JAHA

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BackgroundOff‐pump coronary artery bypass (OPCAB) has been shown to reduce the risk of neurologic complications as compared to coronary artery bypass grafting performed with cardiopulmonary bypass. Side‐clamping of the aorta while constructing proximal anastomoses, however, still carries substantial risk of cerebral embolization. We aimed to perform a comprehensive meta‐analysis of studies assessing 2 clampless techniques: aortic “no‐touch” and proximal anastomosis devices (PAD) for OPCAB.Methods and ResultsPubMed, CINAHL, CENTRAL, and Google Scholar databases were screened for randomized controlled trials and observational studies comparing “no‐touch” and/or PAD with side‐clamp OPCAB and reporting short‐term (≤30 days) outcomes: cerebrovascular accident and all‐cause mortality. A total of 18 studies (3 randomized controlled trials) enrolling 25 163 patients were included. Aortic “no‐touch” was associated with statistically lower risk of cerebrovascular accident as compared to side‐clamp OPCAB: risk ratio 95% CI: 0.41 (0.27–0.61); P<0.01; I2=0%. Event rates were 0.36% and 1.28% for “no‐touch” and side‐clamp OPCAB, respectively. No difference was seen between PAD and side‐clamp OPCAB: 0.71 (0.33–1.55); P=0.39; I2=39%. A trend towards increased 30‐day all‐cause mortality with PAD and no difference with “no‐touch” were observed when compared to side‐clamp OPCAB. In a subset analysis, “no‐touch” consistently reduced the risk of cerebrovascular accident regardless of patients’ baseline risk characteristics. A benefit with PAD was observed in low‐risk patients.ConclusionsAortic “no‐touch” technique was associated with nearly 60% lower risk of postoperative cerebrovascular events as compared to conventional side‐clamp OPCAB with effect consistent across patients at different risk.

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Section: Discussionmentioning

confidence: 99%

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Pawliszak

Kowalewski

Raffa

et al. 2016

JAHA

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“…Two studies 100,104 used minimally invasive surgery and one other compared stenting with internal mammary artery grafting. 102 The remainder of the trials used standard surgical techniques, although the SOS trial 103 indicates that in some institutions standard care may have included minimally invasive surgery.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three studies included patients with multiplevessel disease 101,103,110 and three 100,102,104 included patients with isolated single-vessel (LAD) disease. All but two studies 100,102 explicitly excluded patients who had a history of revascularisation.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three were conducted in Europe only, 100,102,104 one in Europe and Canada, 103 one in Argentina 101 and one that included 67 centres in 18 countries. 99 The study by Drenth and colleagues 104 was single-centred and was conducted in Netherlands.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[99][100][101][102][103][104] Two other trials met the inclusion criteria. One 105 aimed to randomise 280 patients and was completed.…”

Section: Cabg: Included Studies Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NHS R&D HTA ProgrammeT he research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly influence key decision-making bodies such as the National Institute for Clinical Excellence (NICE) and the National Screening Committee (NSC) who rely on HTA outputs to help raise standards of care. HTA findings also help to improve the quality of the service in the NHS indirectly in that they form a key component of the 'National Knowledge Service' that is being developed to improve the evidence of clinical practice throughout the NHS.The HTA Programme was set up in 1993. Its role is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care.The HTA programme commissions research only on topics where it has identified key gaps in the evidence needed by the NHS. Suggestions for topics are actively sought from people working in the NHS, the public...

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Percutaneous transluminal coronary angioplasty with stents versus coronary artery bypass grafting for people with stable angina or acute coronary syndromes

Bakhai

Hill

Dündar

et al. 2005

Cochrane Database of Systematic Reviews

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CABG is associated with reduced rates of major adverse cardiac events, mostly driven by reduced repeat revascularisation. However, the RCT data are limited by follow-up, unrepresentative samples and rapid development of both surgical techniques and stenting. Research on real-world patient population or patient level data meta-analyses may identify risk factors and groupings who may benefit most from one strategy over the other.

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Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery: Six months' angiographic and clinical follow-up of a prospective randomized study

Abstract: After 6 months, surgical intervention had a significantly better angiographic outcome than stenting in patients with an isolated high-grade stenosis of the proximal left anterior descending coronary artery. Clinical outcome did not significantly differ between treatments.

Cited by 50 publications

References 18 publications

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

Coronary artery stents: a rapid systematic review and economic evaluation

Percutaneous transluminal coronary angioplasty with stents versus coronary artery bypass grafting for people with stable angina or acute coronary syndromes

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