Minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for single-vessel disease: a meta-analysis of 2,885 patients
Selected in European Journal of Cardothoracic Surgery by Rylski
Deppe AC, Liakopoulos OJ, Kuhn EW, Slottosch I, Scherner M, Choi YH, Rahmanian PB, Wahlers T
Eur J Cardiothorac Surg 2015;47:397-406
LinkAccess the abstract
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Percutaneous coronary intervention (PCI) and minimally invasive direct coronary artery bypass (MIDCAB) grafting are established treatment options for single-vessel disease of the left anterior descending artery (LAD). Deppe et al. performed a meta-analysis to compare PCI with MIDCAB for LAD revascularisation.
- A total of 2,885 (61% PCI with drug-eluting stents (DESs) and 39% MIDCAB) patients from 6 randomized, controlled and 6 observational trials were included
- PCI patients presented with increased incidence for major adverse cardiac and cerebrovascular events (MACCEs) OR 1.98, 95% CI 1.45-2.69, P<0.0001 6 months after the procedure
- PCI was associated with an increased rate of target vessel revascularisation OR 2.11, 95% CI 1.00-4.47, P<0.05
- There was no differences with regard to stroke, myocardial infarction and mortality between PCI and MIDCAB
- PCI patients had a shorter length of hospital stay (<3.4 days, P<0.0001).
The most used treatment for isolated LAD stenosis is currently PCI. MIDCAB is an alternative for PCI. It is performed through a small left anterior thoracotomy without need for cardiopulmonary bypass on a beating heart. This is the first meta-analysis that compares drug eluting PCI vs. MIDCAB for LAD revascularisation. The authors show superiority of MIDCAB when compared with PCI. Especially, DES failed to demonstrate equivalent low need for secondary intervention when compared with MIDCAB in long-term follow up. There were no differences of adverse periprocedural events between both revascularisation strategies and significantly increased MACCE rates in PCI patients. I agree with the authors who strongly suggest, that MIDCAB is a superior technique for isolated LAD revascularisation.