Background: The trials comparing Minimally Invasive Direct Coronary Artery Bypass Graft (MIDCABG) with Percutaneous Coronary Intervention (PCI) for proximal Left Anterior Descending Artery (LAD) stenosis show conflicting results.
Methods: The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials reporting clinical outcomes of MIDCABG vs PCI in patients with single vessel proximal LAD coronary artery disease. The effect estimates were pooled using Der-Simonian and Laird random-effects meta-analysis models.
Results: Eight randomized trials comprising of 1, 161 patients met inclusion criteria. Median follow up was 18 months (range 6 months to 10 years). Over 6 to 12 month follow up, need for any coronary intervention was significantly lower in MIDCABG compared to PCI [Risk Ratio (RR): 0.28; 95% confidence intervals (CI): 0.16-0.49]. All-cause mortality, myocardial infarction and recurrence of angina were not significantly different among two groups over near or long term [Fig. 1]. Upon follow up of more than a year, Target Vessel Revascularization (RR: 0.30; CI: 0.20-0.46) and need for any coronary intervention (RR: 0.28; CI: 0.15-0.50) were significantly lower in MIDCABG group.
Conclusions: The MIDCABG reduces target vessel revascularizations and need for any coronary intervention in comparison to PCI for single vessel proximal LAD stenosis without increased all-cause mortality, myocardial infarction and recurrence of angina.