Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery

doi:10.1136/bmj.39106.476215.BE

BMJ 2007;334:617 (24 March), doi:10.1136/bmj.39106.476215.BE (published 2 March 2007)

Research

Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery

Omer Aziz, clinical research fellow¹, Christopher Rao, research fellow¹, Sukhmeet Singh Panesar, research fellow¹, Catherine Jones, research fellow¹, Stephen Morris, senior lecturer², Ara Darzi, professor of surgery¹, Thanos Athanasiou, consultant cardiac surgeon¹

¹ Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London W2 1NY, ² Tanaka Business School, Imperial College London

Correspondence to: T Athanasiou tathan5253{at}aol.com

Objective To compare outcomes between minimally invasive leftinternal thoracic artery bypass and percutaneous coronary arterystenting as primary interventions for isolated lesions of theleft anterior descending artery.

Design Meta-analysis of randomised and non-randomised comparativepeer reviewed publications.

Data sources Embase, Medline, Cochrane, Google Scholar, andHealth Technology Assessment databases (1966-2005).

Review methods Studies comparing the two procedures as the primaryintervention for isolated left anterior descending artery stenosiswere identified and the following extracted: study design, populationcharacteristics, severity of coronary artery disease, cardiovascularrisk factors, and outcomes of interest.

Results 12 studies (1952 patients) reporting results from eightgroups were included: one was a retrospective design, one prospectivenon-randomised, and six prospective randomised. Meta-analysisof randomised trials showed a higher rate of recurrence of angina(odds ratio 2.62, 95% confidence interval 1.32 to 5.21), incidenceof major adverse coronary and cerebral events (2.86, 1.62 to5.08), and need for repeat revascularisation (4.63, 2.52 to8.51) with percutaneous stenting. No significant differencewas found in myocardial infarction, stroke, or mortality atmaximum follow-up between interventions.

Conclusions Minimally invasive left internal thoracic arterybypass for isolated lesions of the left anterior descendingartery resulted in fewer complications in the mid-term comparedwith percutaneous transluminal coronary artery stenting.

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