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Eur J Cardiothorac Surg 2006;29:65-70
© 2006 Elsevier Science NL
a Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
b Division of Cardiac Surgery, University of Ottawa Heart Institute, Room H-3401, 40 Ruskin Street, Ottawa, Ont., Canada K1Y 4W7
c Department of Epidemiology, University of Ottawa, Ottawa, Ont., Canada
Received 21 June 2005; received in revised form 25 July 2005; accepted 27 July 2005.
* Corresponding author. Tel.: +1 613 761 4893; fax: +1 613 761 5367. (Email: mruel{at}ottawaheart.ca).
Objective: Despite numerous studies comparing surgical versus percutaneous revascularization, the optimal treatment of patients with isolated left anterior descending (LAD) artery disease remains debated. We conducted a meta-analysis to study the early and mid-term outcomes following percutaneous and surgical treatment of isolated LAD disease. Methods: Medline, EMBASE, and the Cochrane databases were searched and a hand search of bibliographies was conducted. Clinical data was extracted independently by two individuals. Random effects models were used to calculate pooled risk ratios (RR) and meta-regression was employed to explain study heterogeneity. Stratified analyses were conducted and a Funnel plot was used to assess publication bias. Results: Eight randomized trials (1110 patients; median follow-up: 2.1 years, range: 0.5–5 years) and nine observational studies (12,209 patients; median follow-up: 3 years, range: 0.5–5.5 years) were identified and analyzed separately. Both randomized and observational studies demonstrated a beneficial effect of surgery compared to percutaneous therapy on mid-term major adverse cardiac events (MACE) (RR [95% CI]: 0.33 [0.24–0.46] for randomized and 0.32 [0.24–0.41] for observational studies). Studies with >1 year of follow-up demonstrated a beneficial effect of surgery compared to percutaneous therapy on combined mortality and MI rates for randomized (RR [95% CI]: 0.59 [0.35–0.98]) and observational studies (RR [95% CI]: 0.81 [0.65–0.99]). The start year was identified as a source of study heterogeneity. Conclusions: Surgical treatment of isolated LAD disease is associated with reduced MACE, reduced mortality, and MI rates at mid-term follow-up, as well as lower recurrence of angina. Evolution of treatment strategies may explain some of the variability between studies.
Key Words: Coronary artery bypass • Minimally invasive coronary artery bypass (MIDCAB) • Percutaneous transluminal coronary angioplasty • Stents • Meta-analysis • Mortality • Myocardial infarction
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