Abstract 18517: Single Vessel Disease - Surgical or Interventional treatment a Systematic Review With Meta-analysis of 3,491 Patients
Introduction: Minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI) are both established therapeutic options for single vessel disease of the left anterior descending artery (LAD). Internal mammary artery grafts (IMA) has proven survival benefits and 10 year patency rates greater than 90% after LAD revascularization. However, due to lower costs, quicker recovery and lesser invasiveness PCI with stenting it the most common used treatment for isolated LAD stenosis.
Hypothesis: The present systematic review with meta-analysis aims to determine the current evidence for MIDCAB or PCI for revascularization of the LAD.
Methods: We performed a meta-analysis of randomized (RCT) and observational trials (OT) that reported clinical outcome after isolated LAD revascularization. Pooled treatment effects (odds ratio (OR) or weighted mean difference (WMD), 95% confidence intervals (95%CI)) were assessed using a fixed or random effects model.
Results: A total of 3,491 patients from 13 studies (6 RCT, 7 OT) were identified. Increased incidence for repeat target vessel revascularization (TVR) after PCI was already in existence six month after the procedure (OR 1.98; 95%CI 1.45-2.69; p<0.001). Subgroup analysis of studies using drug-eluting stents (n=1.547) revealed a significant absolute risk reduction of 8.8% (p=0.008). Only subgroup analysis of studies rated as being of high quality revealed an impact on all-cause mortality in a median follow-up of 4.7 years (OR 1.46; 95%CI 1.03-2.06; p<0.029). No differences with regard to stroke were observed between both revascularization strategies.
Conclusions: Current evidence reported in this systematic review suggests MIDCAB for treatment of single vessel disease of the LAD.
Author Disclosures: A.C. Deppe: None. O.J. Liakopoulos: None. Y. Choi: None. E.W. Kuhn: None. I. Slottosch: None. M. Scherner: None. P.B. Rahmanian: None. T. Wahlers: None.
- © 2014 by American Heart Association, Inc.