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

BMJ 2007; 334 doi: (Published 22 March 2007) Cite this as: BMJ 2007;334:617
  1. Omer Aziz, clinical research fellow1,
  2. Christopher Rao, research fellow1,
  3. Sukhmeet Singh Panesar, research fellow1,
  4. Catherine Jones, research fellow1,
  5. Stephen Morris, senior lecturer2,
  6. Ara Darzi, professor of surgery1,
  7. Thanos Athanasiou, consultant cardiac surgeon1
  1. 1Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London W2 1NY
  2. 2Tanaka Business School, Imperial College London
  1. Correspondence to: T Athanasiou tathan5253{at}
  • Accepted 5 January 2007


Objective To compare outcomes between minimally invasive left internal thoracic artery bypass and percutaneous coronary artery stenting as primary interventions for isolated lesions of the left anterior descending artery.

Design Meta-analysis of randomised and non-randomised comparative peer reviewed publications.

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

Review methods Studies comparing the two procedures as the primary intervention for isolated left anterior descending artery stenosis were identified and 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 a retrospective design, one prospective non-randomised, and six prospective randomised. Meta-analysis of randomised trials showed a higher rate of recurrence of angina (odds ratio 2.62, 95% confidence interval 1.32 to 5.21), incidence of major adverse coronary and cerebral events (2.86, 1.62 to 5.08), and need for repeat revascularisation (4.63, 2.52 to 8.51) with percutaneous stenting. No significant difference was found in myocardial infarction, stroke, or mortality at maximum follow-up between interventions.

Conclusions Minimally invasive left internal thoracic artery bypass for isolated lesions of the left anterior descending artery resulted in fewer complications in the mid-term compared with percutaneous transluminal coronary artery stenting.


  • Contributors: OA was responsible for the study design, statistical analysis, data interpretation, manuscript drafting and revision for important intellectual content. CR, SSP, and CJ were responsible for the collection, extraction, analysis, and interpretation of the data. SM was responsible for manuscript design and statistical analysis. AD was responsible for providing important intellectual content throughout the manuscript's production and for approval of the final version. TA is the guarantor. His involvement was critical to every phase of this work and he had access to the data and controlled the decision to publish.

  • Funding: This study was undertaken as part of ongoing research at the Department of Biosurgery and Surgical Technology, Imperial College London, and did not receive separate funding.

  • Competing interests: None declared.

  • Ethical approval: Not required.

  • Accepted 5 January 2007
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