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Eur J Cardiothorac Surg 2007;31:691-697. doi:10.1016/j.ejcts.2007.01.018
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
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a Department of Internal Medicine Henry Ford Hospital, Detroit, MI, United States
b Henry Ford Heart and Vascular Institute, Detroit, MI, United States
Received 10 October 2006; received in revised form 4 December 2006; accepted 15 January 2007.
* Corresponding author. Address: Henry Ford Heart and Vascular Institute, 2799 W Grand Blvd, Detroit, MI 40202, United States. Tel.: +1 313 916 7930. (Email: skhanal1{at}hotmail.com).
Percutaneous intervention (PCI) and minimally invasive direct coronary bypass grafting (MIDCAB) are both well-accepted treatment options for isolated high-grade stenosis of proximal left anterior descending coronary artery. Small studies comparing the two modalities have yielded conflicting results. We performed a meta-analysis of randomized control trials to compare percutaneous intervention with minimally invasive coronary bypass grafting for isolated proximal left anterior descending artery stenosis. Five randomized trials with a total of 711 patients and average follow-up of 2.3 years were included in the analysis; 380 patients received stents and 331 underwent surgery. Only one trial used drug eluting stents. There were a small number of events overall in each trial. Difference between mortality was 12 events versus 15 between the PCI versus MIDCAB group. Similarly, the difference in myocardial infarction was 14 versus 10, and target vessel revascularization was 56 versus 19. The relative risk for stenting versus MIDCAB was 0.96 [(95% CI: 0.47, 1.99), p = 0.92, I 2 = 17.5%], for mortality and myocardial infarction, 0.77 [(95% CI: 0.30, 2.01), p = 0.60, I 2 = 10.4%] for mortality and 1.81 [(95% CI: 0.80, 4.06), p = 0.15, I 2 = 65.9%] for the composite end point of mortality, myocardial infarction and target vessel revascularization. Excluding the trial with drug eluting stents the relative risk for the composite outcome of mortality, myocardial infarction and target vessel revascularization was significantly higher for PCI [RR = 2.27 (95% CI: 1.32, 3.90), p = 0.003, I 2 = 18.9%]. Overall mortality and myocardial infarction rates are similar for bare metal stents versus MIDCAB, but surgery was associated with significantly lower rates of repeat revascularization. The number of randomized patients and events were small. The effect of drug eluting stents might close the gap of repeat revascularization compared to MIDCAB for this disease.
Key Words: LAD stenosis • Percutaneous coronary intervention • Minimally invasive bypass grafting • Outcome
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