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J Thorac Cardiovasc Surg 2007;134:548
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

A meta-analysis of minimally invasive coronary artery bypass versus percutaneous coronary intervention with stenting for isolated left anterior descending artery disease is indispensable

Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan

To the Editor:

We read with great interest a meta-analysis of randomized trials of off-pump coronary artery bypass versus percutaneous coronary intervention (PCI) by Bainbridge and associates.¹ In response to a meta-analysis by Boodhwani and colleagues² of randomized trials comparing surgical versus percutaneous treatment of isolated left anterior descending (LAD) artery disease, we³ conducted a meta-analysis of then-available 5 trials of minimally invasive direct coronary artery bypass (MIDCAB) versus PCI with stenting in the form of a letter to the editor. In the meta-analysis by Boodhwani and coworkers,² significant heterogeneity existed because of the inclusion of both conventional coronary artery bypass and MIDCAB in the surgical group and both PCI with or without stenting in the percutaneous group. So far as the meta-analysis by Bainbridge and associates¹ is concerned, although 5 of 6 included trials used MIDCAB technique in the majority of patients in the surgical arm, in 1 trial by Eefting and colleagues⁴ (the largest trial in the 6 trials) surgical access to the heart was achieved via median sternotomy in 67%. Although the trial by Eefting and coworkers⁴ included patients with multivessel disease, the other 5 trials were exclusively of LAD stenting versus left internal thoracic artery–to–LAD anastomosis. Furthermore, a flaw of the systematic review by Bainbridge and associates¹ was missing a trial by Kim and colleagues⁵ published in 2005 despite comprehensive searches up until May 2006. Therefore, we would like to advocate a meta-analysis of currently available 6 homogeneous randomized trials of MIDCAB versus PCI with stenting for isolated LAD disease, including the trial by Kim and coworkers⁵ and 5 trials except for the trial by Eefting and associates⁴ included in the meta-analysis by Bainbridge and colleagues.¹

References

1. Bainbridge D, Cheng D, Martin J, Novick R, Evidence-based Peri-operative Clinical Outcomes Research (EPiCOR) Group Does off-pump or minimally invasive coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with percutaneous coronary intervention?. A meta-analysis of randomized trials. J Thorac Cardiovasc Surg 2007;133:623-631.[Abstract/Free Full Text]
   
2. Boodhwani M, Rubens FD, Sellke FW, Mesana TG, Ruel M. Mortality and myocardial infarction following surgical versus percutaneous revascularization of isolated left anterior descending artery disease: a meta-analysis. Eur J Cardiothorac Surg 2006;29:65-70.[Abstract/Free Full Text]
   
3. Takagi H, Kato T, Matsuno Y, Umemoto T. Minimally invasive direct coronary artery bypass versus stenting. Eur J Cardiothorac Surg 2006;29:632.[Free Full Text]
   
4. Eefting F, Nathoe H, van Dijk D, Jansen E, Lahpor J, Stella P, et al. Randomized comparison between stenting and off-pump bypass surgery in patients referred for angioplasty. Circulation 2003;108:2870-2876.[Abstract/Free Full Text]
   
5. Kim JW, Lim DS, Sun K, Shim WJ, Rho YM. Stenting or MIDCAB using ministernotomy for revascularization of proximal left anterior descending artery?. Int J Cardiol 2005;99:437-441.[Medline]
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hisato Takagi Takuya Umemoto Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Takagi, H. Articles by Umemoto, T. Search for Related Content PubMed PubMed Citation Articles by Takagi, H. Articles by Umemoto, T. Related Collections Minimally invasive surgery Related Article