Minimally invasive direct coronary artery bypass versus stenting

Abstract

We readwith great interest the article by Boodhwani et al. [1] titled ‘Mortality and myocardial infarction following surgical versus percutaneous revascularization of isolated left anterior descending artery disease: a meta-analysis’. Randomized studies demonstrated a beneficial effect of surgery compared to percutaneous therapy on mid-term (1 month to 5 years) major adverse cardiac events (MACE) with a risk ratio (RR) of 0.33 (95% confidence interval [CI]: 0.24, 0.46). In the meta-analysis by Boodhwani et al. [1], however, there was substantial qualitative heterogeneity in trial design: surgical treatment was conventional coronary artery bypass grafting (CABG) in two trials, minimally invasive direct coronary artery bypass (MIDCAB) in five trials and CABG/ MIDCAB in one trial; percutaneous treatment was angioplasty without stent in two trials, with stent in five trials, and with drug eluting stent in one trial. As stated by Boodhwani et al. [1], type of surgical treatment and type of percutaneous treatment were significant predictors of MACE. Therefore, we conducted a meta-analysis of randomized controlled trials of MIDCAB versus stenting for isolated left anterior descending (LAD) artery disease. All randomized controlled trials of MIDCAB versus stenting enrolling patients with isolated LAD disease were identified by means of searching MEDLINE between January 1966 and December 2005.