Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2007 Mar 24;334(7594):617.
doi: 10.1136/bmj.39106.476215.BE. Epub 2007 Mar 2.

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, Sukhmeet Singh Panesar, Catherine Jones, Stephen Morris, Ara Darzi, Thanos Athanasiou
Affiliations
Meta-Analysis

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

Omer Aziz et al. BMJ. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

None
Fig 1 Forest plot showing results from meta-analysis of randomised trials reporting need for repeat revascularisation at maximum follow-up, recurrence of angina, and major adverse coronary and cerebral event after minimally invasive thoracic artery bypass compared with transluminal stenting
None
Fig 2 Forest plot showing results from meta-analysis of randomised trials reporting postoperative myocardial infarction, myocardial infarction at maximum follow-up, mortality at maximum follow-up, and post-procedural stroke or transient ischaemic attack after minimally invasive thoracic artery bypass compared with transluminal stenting
None
Fig 3 Scatter plot of studies reporting need for repeat revascularisation at maximum follow-up
None
Fig 4 Scatter plot of randomised studies reporting need for repeat revascularisation at maximum follow-up
See this image and copyright information in PMC

Comment in

  • Coronary revascularisation.
    Taggart DP. Taggart DP. BMJ. 2007 Mar 24;334(7594):593-4. doi: 10.1136/bmj.39154.552280.BE. BMJ. 2007. PMID: 17379861 Free PMC article.
  • To stent or not to stent?: A sterile debate.
    Westaby S, Channon K, Banning A. Westaby S, et al. BMJ. 2007 Jul 21;335(7611):111. doi: 10.1136/bmj.39273.655694.BE. BMJ. 2007. PMID: 17641307 Free PMC article. No abstract available.

References

    1. Poyen V, Silvestri M, Labrunie P, Valeix B. Indications of coronary angioplasty and stenting in 2003: what is left to surgery? J Cardiovasc Surg (Torino) 2003;44:307-12. - PubMed
    1. Opie LH, Commerford PJ, Gersh BJ. Controversies in stable coronary artery disease. Lancet 2006;367:69-78. - PubMed
    1. Meads C, Cummins C, Jolly K, Stevens A, Burls A, Hyde C. Coronary artery stents in the treatment of ischaemic heart disease: a rapid and systematic review. Health Technol Assess 2000;4:1-153. - PubMed
    1. Versaci F, Gaspardone A, Tomai F, Proietti I, Ghini AS, Altamura L, et al. A comparison of coronary artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery: five year clinical follow up. Heart 2004;90:672-5. - PMC - PubMed
    1. Niinami H, Takeuchi Y, Ichikawa S, Suda Y. Partial median sternotomy as a minimal access for off-pump coronary artery bypass grafting: feasibility of the lower-end sternal splitting approach. Ann Thorac Surg 2001;72(3):S1041-5. - PubMed

MeSH terms