Meta-analysis of MIDCABG versus DES for isolated LAD disease

The study aims to compare outcomes between minimally invasive coronary artery bypass (MINI–CAB) and drug–eluting stent (DES) implantation for isolated left anterior descending (LAD) disease. Given the available evidence, MINI–CAB results in lower TVR rates, but otherwise similar clinical outcomes when compared with DES in patients with LAD disease.

Methods

• Randomized and observational comparative publications were identified using Medline and Google Scholar databases (January 2003 until December 2013).
• Studies without outcome data, without DES use, or utilizing conventional bypass surgery, were excluded.
• Outcomes of interest were cardiac death, myocardial infarction (MMI), target vessel revascularization (TVR) and peri-procedural stroke.
• Data were compared using the Mantel Haenszel methods, and presented as odds ratio (OR) with 95% confidence interval, and number needed to treat (NNT).

Results

• From 230 publications, the authors identified 4 studies (2 randomized and 2 observational) that included a total of 941 patients (478 underwent MINI-CAB, and 463 received DES).
• The incidence of TVR at maximum follow-up (6-60 months) was significantly lower in the MINI-CAB group (OR:0.16 [0.08-0.30], p<0.0001, NNT=13).
• Cardiac mortality and MI were similar between MINICAB and DES at follow-up (OR:1.05 [0.44-2.47] and OR:0.83 [0.43-1.58], respectively). In addition, similar peri-procedural death (OR: 0.85 [0.21-3.47], p=0.82), MI (OR: 0.98 [0.38-2.58], p=0.97) and stroke (OR: 1.36 [0.28-6.70], p=0.70) were observed between the two treatment modalities.