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, 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 ¹, Christopher Rao ¹, Sukhmeet Singh Panesar ¹, Catherine Jones ¹, Stephen Morris ², Ara Darzi ¹, Thanos Athanasiou ¹^*

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: 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 randomisedand non-randomised comparative peer reviewed publications.

Datasources Embase, Medline, Cochrane, Google Scholar, and HealthTechnology Assessment databases (1966-2005).

Review methods Studiescomparing the two procedures as the primary intervention forisolated left anterior descending artery stenosis were identifiedand the following extracted: study design, population characteristics,severity of coronary artery disease, cardiovascular risk factors,and outcomes of interest.

Results 12 studies (1952 patients)reporting results from eight groups were included: one was aretrospective design, one prospective non-randomised, and sixprospective randomised. Meta-analysis of randomised trials showeda higher rate of recurrence of angina (odds ratio 2.62, 95%confidence interval 1.32 to 5.21), incidence of major adversecoronary and cerebral events (2.86, 1.62 to 5.08), and needfor repeat revascularisation (4.63, 2.52 to 8.51) with percutaneousstenting. No significant difference was found in myocardialinfarction, stroke, or mortality at maximum follow-up betweeninterventions.

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

(Accepted 5 January 2007)

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