Percutaneous Coronary Intervention or Minimally Invasive Coronary Bypass for Isolated Left Anterior Descending Artery
Alan Gallingani1, Giulia Pampuri2, Nadim Diab2
1Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy.
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) offer comparable long-term survival for isolated left anterior descending artery disease. MIDCAB significantly reduces repeat revascularization and major adverse cardiovascular events.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Optimal revascularization for isolated left anterior descending (LAD) artery disease is debated.
- Minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) are key treatment options.
Purpose of the Study:
- To compare long-term outcomes of MIDCAB versus PCI in patients with isolated LAD artery disease.
- To evaluate differences in survival, repeat target vessel revascularization (TVR), and major adverse cardiovascular events (MACEs).
Main Methods:
- Updated meta-analysis of randomized controlled trials (RCTs) and adjusted studies.
- Systematic search of three databases.
- Random effects model used for meta-analysis.
Main Results:
- Long-term survival was comparable between MIDCAB and PCI (HR = 0.76; p = 0.05).
- MIDCAB showed significantly lower rates of repeat TVR (HR = 0.35; p <0.0001) and MACEs (HR = 0.59; p <0.0001).
- Subgroup analysis of drug-eluting stents did not show a significant difference for MACEs.
Conclusions:
- MIDCAB and PCI provide similar long-term survival for isolated LAD lesions.
- MIDCAB demonstrates a significant advantage in reducing long-term repeat TVR and MACEs compared to PCI.
Abstract:
The optimal revascularization strategy for isolated left anterior descending (LAD) artery disease, minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI), remains a subject of debate. This updated meta-analysis aimed to compare the long-term outcomes of MIDCAB versus PCI for patients with isolated LAD artery disease. Three databases were systematically searched to identify randomized controlled trials (RCTs) and adjusted studies. Primary outcomes included long-term survival and repeat target vessel revascularization (TVR). The secondary endpoint was long-term major adverse cardiovascular events (MACEs). Hazards ratios (HR) and Confidence Intervals (CI) were calculated for long-term outcomes and a random effects model was used. Sensitivity analyses included subgroups analysis of stent-type. Nine articles, comprising 4 RCTs, totaling 2,168 patients (MIDCAB = 1,086 and PCI = 1,080) were included. The weighted mean follow-up was 4.35 ± 4.9 years. Long-term survival was comparable between MIDCAB and PCI (HR = 0.76; 95% CI, 0.58 to 1.00; p = 0.05). MIDCAB was associated with a significantly lower rate of repeat TVR (HR = 0.35; 95% CI, 0.25 to 0.49; p <0.0001) and a reduced risk of MACEs (HR = 0.59; 95% CI, 0.43 to 0.81; p <0.0001), although the difference was not evident in subgroup analysis comparing MIDCAB and PCI with drug-eluting stent (HR = 0.66; 95% CI, 0.46 to 1.06; p = 0.09). In conclusion, this meta-analysis of RCTs and adjusted studies shows that in patients with isolated LAD lesion, MIDCAB and PCI exhibit comparable long-term survival. However, MIDCAB is associated with a significantly reduced risk of long-term repeat TVR and MACEs compared to PCI.
