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Minimally Invasive Direct Coronary Artery Bypass Versus Percutaneous Coronary Intervention for Isolated Left Anterior

Shijie Zhang1, Shanghao Chen2, Kun Yang3

  • 1Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China. 17853138359@163.com.

The Heart Surgery Forum
|March 1, 2023
PubMed

Insights

Minimally invasive direct coronary artery bypass (MIDCAB) shows reduced long-term major adverse cardiovascular events (MACE) and target vessel revascularization (TVR) compared to percutaneous coronary intervention (PCI) for isolated left anterior descending lesions. No significant differences in survival or short-term outcomes were observed.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • The optimal revascularization strategy for isolated left anterior descending (LAD) lesions remains debated.
  • Minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) are primary treatment options.
  • This meta-analysis compares long- and short-term outcomes of MIDCAB versus PCI for isolated LAD lesions.

Approach:

  • Searched Pubmed, Web of Science, and Cochrane databases (2002-2022).
  • Included 6 randomized controlled trials (RCTs) and 8 observational studies.
  • Analyzed 1757 patients in the MIDCAB group and 15245 patients in the PCI group.

Key Points:

  • No significant difference in long-term survival between MIDCAB and PCI.
  • MIDCAB demonstrated a lower rate of long-term major adverse cardiovascular events (MACE).
  • PCI was associated with an increased risk of long-term target vessel revascularization (TVR).
  • Short-term outcomes including mortality, myocardial infarction, TVR, and MACE were similar.

Conclusions:

  • MIDCAB offers reduced long-term TVR and MACE compared to PCI for isolated LAD lesions.
  • No significant advantage of MIDCAB over PCI in long-term mortality or short-term results.
  • Further large multicenter RCTs are needed to evaluate newer techniques.
Abstract

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