Minimally invasive direct coronary bypass compared with percutaneous coronary intervention for left anterior descending artery disease: a meta-analysis

Abstract

BackgroundThe clinical outcomes for left anterior descending (LAD) coronary artery lesion between minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) are still controversial. The objective was to compare safety and efficacy between MIDCAB and PCI for LAD.MethodsElectronic databases and article references were systematically searched to access relevant studies. End points included mortality, myocardial infarction, target vessel revascularization (TVR), major adverse coronary events (MACE), angina recurrence, and stroke.ResultsFourteen studies with 941 patients were finally involved in the present study. The mortality and incidence of myocardial infarction were similar in MIDCAB and PCI groups at 30 days, 6 months, and at follow-up beyond 1 year. Compared with PCI, MIDCAB decreased incidence of TVR and MACE at 6 months and beyond 1 year follow-up. MIDCAB was associated with a lower incidence of angina recurrence at 6 months compared with PCI. PCI was associated with higher risk of restenosis in target vessel. No significant difference was shown for stroke.ConclusionOur meta-analysis indicates that there are no significant differences in the safety between MIDCAB and PCI in patients with LAD. However MIDCAB is superior to PCI for TVR and MACE.

2018 ESC/EACTS Guidelines on myocardial revascularization

“…144 Moreover, when compared with PCI in a setting of single-vessel proximal LAD disease, minimally invasive coronary surgery was associated with less need for coronary reintervention. 143,534,535 When combined with PCI to non-LAD vessels, it provides the opportunity for hybrid coronary revascularization to be performed in selected patients with multivessel disease. 536 Hybrid revascularization can be performed consecutively in a hybrid operating room, or sequentially on separate occasions in the conventional surgical and PCI environments.…”

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 ―

“…Myocardial infarction (MI), allcause death, and cardiovascular death rates were not different between the 2 treatment options, whereas MIDCAB had favorable results compared with PCI in terms of target vessel revascularization (TVR). [5][6][7][8][9][10][11][12] With newer generation drug-eluting stents (DES), however, the in-stent restenosis (ISR) rate of coronary stents decreased from 20% in the bare metal stent (BMS) era to <10% in the second-generation DES era. 13 Nevertheless, most randomized controlled trials (RCT) that compared PCI and MIDCAB were conducted using BMS or firstgeneration DES during the early 2000s.…”

“…13 Nevertheless, most randomized controlled trials (RCT) that compared PCI and MIDCAB were conducted using BMS or firstgeneration DES during the early 2000s. [5][6][7][8][9][10][11][12] Furthermore, in the contemporary clinical environment with patients preferring non-surgical options, the possibility of conducting randomized controlled studies that compare PCI and MIDCAB is limited. 14,15 The development of hybrid coronary revascularization has led to a steady rise in the occurrence of these complicated conditions.…”

Short and long-term results of endoscopic atraumatic coronary artery off-pump bypass grafting in patients with left anterior descending artery stenosis

“…The procedure is most widely applied in the single vessel disease of the left anterior descending coronary artery (LAD), as a hybrid procedure (along with stenting of other vessels in patients treated for multi-vessel disease), in patients unable to undergo the complete CABG revascularization and as a palliative therapy in patients with in-stent restenosis [3,4]. Studies have proven the efficacy and safety of the MIDCAB procedure in comparison to both CABG and PCI [5][6][7][8]. It is estimated that MIDCAB may be indicated in 2-8% of patients primarily qualified for CABG.…”