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Gianoli M, de Jong AR, Jacob KA, Namba HF, van der Kaaij NP, van der Harst P, J.L Suyker W. Minimally invasive surgery or stenting for left anterior descending artery disease – meta-analysis. IJC HEART & VASCULATURE 2022; 40:101046. [PMID: 35573649 PMCID: PMC9098394 DOI: 10.1016/j.ijcha.2022.101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022]
Abstract
Minimally invasive direct coronary artery bypass (MIDCAB) surgery and percutaneous coronary intervention (PCI) are both well-established minimally invasive revascularization strategies in patients with proximal left anterior descending (LAD) lesions. We aimed to evaluate the 20-years’ experience by performing a systematic review and meta-analysis comparing MIDCAB versus PCI in adults with proximal LAD disease. We searched MEDLINE, EMBASE and Cochrane on October 1st, 2021 for articles published in the year 2000 or later. The primary outcome was all-cause mortality. Secondary outcomes included cardiac mortality, repeat target vessel revascularization (rTVR), myocardial infarction (MI), and cerebrovascular accident (CVA). Outcomes were analysed at short-term, mid-term, and long-term follow-up. Random effects meta-analyses were performed. Events were compared using risk ratios (RR) with 95% confidence intervals (CI). Our search yielded 17 studies pooling 3847 patients. At short-term follow-up, cardiac mortality was higher with MIDCAB than with PCI (RR 7.30, 95% CI: 1.38 to 38.61). At long-term follow-up, MIDCAB showed a decrease in all-cause mortality (RR 0.66, 95% CI: 0.46 to 0.93). MIDCAB showed a decrease in rTVR at mid-term follow-up (RR 0.16, 95% CI: 0.11 to 0.23) and at long-term follow-up (RR 0.25, 95% CI: 0.17 to 0.38). MI and CVA comparisons were not significant. In conclusion, in patients with proximal LAD lesions, MIDCAB showed a higher short-term mortality in the RCTs, but the cohort studies suggested a lower all-cause mortality at long-term follow-up. We confirm a decreased rTVR at mid-term follow-up in the RCTs and long-term follow-up in the cohort studies.
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Affiliation(s)
- Monica. Gianoli
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Corresponding author at: Heidelberglaan 100, 3508 GA Utrecht, the Netherlands.
| | - Anne R. de Jong
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kirolos A. Jacob
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hanae F. Namba
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Niels P. van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem J.L Suyker
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Petrosyan H, Hayrapetyan H, Torozyan S, Tsaturyan A, Tribunyan S. In-hospital complications in acute ST-elevation myocardial infarction depending on renal function. Herzschrittmacherther Elektrophysiol 2021; 32:359-364. [PMID: 34255141 DOI: 10.1007/s00399-021-00782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To analyze in-hospital complications in patients with acute ST-elevation myocardial infarction (STEMI) depending on renal function. DESIGN Observational study in patients with STEMI. METHODS The study included 169 patients undergoing primary percutaneous coronary intervention. In all patients glomerular filtration rate (GRF) was calculated using the Modification of Diet in Renal Disease Study (MDRD) equation. Of these patients, 84 had a GFR ≥ 90 ml/min/1.73 m2 (Group 1) and 85 < 90 ml/min/1.73 m2 (Group 2). Other parameters in both groups were comparable. Study groups were followed to compare Killip class > 2 acute heart failure, in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation, new onset atrial fibrillation, and high grade atrioventricular block. All patients were treated according to European Society of Cardiology (ESC) guidelines for the management of acute myocardial infarction in patients presenting with ST elevation. RESULTS Mean GFR in Group 1 was 107.6 [Formula: see text] and in Group 2 75.3 [Formula: see text] 11.2 (p < 0.0001). The incidence of atrial fibrillation was higher in Group 2: in Group 1 and Group 2 the atrial fibrillation rate was 1.12% (one of 84) vs 8.24% (seven of 85) (p = 0.031), respectively. Group 1 revealed significantly lower rates of acute heart failure (Killip class > 2): in Group 1 and Group 2 0% (0 of 84 patients) vs 5.88% (five of 85 patients) (p = 0.024), respectively. The authors found no significant differences for other complications: in Group 1 and Group 2 ventricular tachycardia or ventricular fibrillation was 4.76% (four of 84 patients) vs 5.89% (five of 85 patients) (p = 0.75), high grade atrioventricular block was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), and the in-hospital pneumonia rate was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), respectively. CONCLUSION Patients with lower GFR were more likely to suffer from in-hospital acute heart failure (Killip class > 2) and atrial fibrillation in STEMI despite primary percutaneous coronary intervention. Renal function did not affect in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation rates. The evaluation of kidney function through GFR in STEMI patients may make in-hospital complications more predictable.
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3
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Serruys PW, Ono M, Garg S, Hara H, Kawashima H, Pompilio G, Andreini D, Holmes DR, Onuma Y, King Iii SB. Percutaneous Coronary Revascularization: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2021; 78:384-407. [PMID: 34294273 DOI: 10.1016/j.jacc.2021.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 01/09/2023]
Abstract
Over the last 4 decades, percutaneous coronary intervention has evolved dramatically and is now an acceptable treatment option for patients with advanced coronary artery disease. However, trialists have struggled to establish the respective roles for percutaneous coronary intervention and coronary artery bypass graft surgery, especially in patients with multivessel disease and unprotected left-main stem coronary artery disease. Several pivotal trials and meta-analyses comparing these 2 revascularization strategies have enabled the relative merits of each technique to be established with regard to the type of ischemic syndrome, the coronary anatomy, and the patient's overall comorbidity. Precision medicine with individualized prognosis is emerging as an important method of selecting treatment. However, the never-ending advancement of technology, in conjunction with the emergence of novel pharmacological agents, will in the future continue to force us to reconsider the evolving question: "Which treatment strategy is better and for which patient?"
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Affiliation(s)
- Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland
| | - Spencer B King Iii
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Bonatti J, Wallner S, Crailsheim I, Grabenwöger M, Winkler B. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J Thorac Dis 2021; 13:1922-1944. [PMID: 33841980 PMCID: PMC8024818 DOI: 10.21037/jtd-20-1535] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra- and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.
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Affiliation(s)
- Johannes Bonatti
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Stephanie Wallner
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Ingo Crailsheim
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Bernhard Winkler
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
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5
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Gaudino M, Hameed I, Farkouh ME, Rahouma M, Naik A, Robinson NB, Ruan Y, Demetres M, Biondi-Zoccai G, Angiolillo DJ, Bagiella E, Charlson ME, Benedetto U, Ruel M, Taggart DP, Girardi LN, Bhatt DL, Fremes SE. Overall and Cause-Specific Mortality in Randomized Clinical Trials Comparing Percutaneous Interventions With Coronary Bypass Surgery: A Meta-analysis. JAMA Intern Med 2020; 180:1638-1646. [PMID: 33044497 PMCID: PMC7551235 DOI: 10.1001/jamainternmed.2020.4748] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Mortality is a common outcome in trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG). Controversy exists regarding whether all-cause mortality or cardiac mortality is preferred as a study end point, because noncardiac mortality should be unrelated to the treatment. OBJECTIVE To evaluate the difference in all-cause and cause-specific mortality in randomized clinical trials (RCTs) comparing PCI with CABG for the treatment of patients with coronary artery disease. DATA SOURCES MEDLINE (1946 to the present), Embase (1974 to the present), and the Cochrane Library (1992 to the present) databases were searched on November 24, 2019. Reference lists of included articles were also searched, and additional studies were included if appropriate. STUDY SELECTION Articles were considered for inclusion if they were in English, were RCTs comparing PCI with drug-eluting or bare-metal stents and CABG for the treatment of coronary artery disease, and reported mortality and/or cause-specific mortality. Trials of PCI involving angioplasty without stenting were excluded. For each included trial, the publication with the longest follow-up duration for each outcome was selected. DATA EXTRACTION AND SYNTHESIS For data extraction, all studies were reviewed by 2 independent investigators, and disagreements were resolved by a third investigator in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Data were pooled using fixed- and random-effects models. MAIN OUTCOMES AND MEASURES The primary outcomes were all-cause and cause-specific (cardiac vs noncardiac) mortality. Subgroup analyses were performed for PCI trials using drug-eluting vs bare-metal stents and for trials involving patients with left main disease. RESULTS Twenty-three unique trials were included involving 13 620 unique patients (6829 undergoing PCI and 6791 undergoing CABG; men, 39.9%-99.0% of study populations; mean age range, 60.0-71.0 years). The weighted mean (SD) follow-up was 5.3 (3.6) years. Compared with CABG, PCI was associated with a higher rate of all-cause (incidence rate ratio, 1.17; 95% CI, 1.05-1.29) and cardiac (incidence rate ratio, 1.24; 95% CI, 1.05-1.45) mortality but also noncardiac mortality (incidence rate ratio, 1.19; 95% CI, 1.00-1.41). CONCLUSIONS AND RELEVANCE Percutaneous coronary intervention was associated with higher all-cause, cardiac, and noncardiac mortality compared with CABG at 5 years. The significantly higher noncardiac mortality associated with PCI suggests that even noncardiac deaths after PCI may be procedure related and supports the use of all-cause mortality as the end point for myocardial revascularization trials.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.,Section of Cardiothoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Ajita Naik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Yongle Ruan
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Michelle Demetres
- Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville
| | - Emilia Bagiella
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary E Charlson
- Division of General Internal Medicine, Weill Cornell Medical College, New York, New York
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David P Taggart
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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6
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Hannan EL, Zhong Y, Cozzens K, Adams DH, Girardi L, Chikwe J, Wechsler A, Sundt TM, Smith CR, Gold JP, Lahey SJ, Jordan D. Revascularization for Isolated Proximal Left Anterior Descending Artery Disease. Ann Thorac Surg 2020; 112:555-562. [PMID: 33144114 DOI: 10.1016/j.athoracsur.2020.08.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/01/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most studies of patients with isolated proximal left anterior descending (PLAD) coronary artery disease do not include all 3 procedural options: percutaneous coronary intervention (PCI), conventional coronary artery bypass graft (CABG) surgery, or minimally invasive CABG. METHODS New York's cardiac registries were used to identify patients who underwent revascularization for isolated PLAD disease between January 1, 2010, and November 30, 2016, in New York State. After exclusions, 14,327 patients, of whom 13,115 received PCI, 1001 of whom underwent CABG surgery, and 211 of whom underwent minimally invasive CABG were monitored through the end of 2017 to compare outcomes. Registry data were matched to vital statistics data to obtain deaths occurring after discharge and matched to claims data to obtain subsequent admissions for myocardial infarction and stroke. RESULTS There were no significant differences in mortality or in mortality/myocardial infarction/stroke after 7 years (with median follow-up times in excess of 4 years) among the 3 procedures after adjusting for differences in patient risk factors. However, conventional CABG surgery was associated with a lower subsequent revascularization rate than PCI (adjusted hazard ratio, 0.45; 95% confidence interval, 0.35-0.58) and minimally invasive CABG surgery (adjusted hazard ratio, 0.46; 95% confidence interval, 0.32-0.66). CONCLUSIONS Among patients with isolated PLAD disease undergoing any of 3 revascularization options (PCI, conventional CABG surgery, or minimally invasive CABG surgery), conventional CABG surgery was associated with lower subsequent revascularization rates, but there were no differences in mortality or mortality/myocardial infarction/stroke rates.
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Affiliation(s)
- Edward L Hannan
- School of Public Health, University at Albany, State University of New York, Albany, New York.
| | - Ye Zhong
- School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Kimberly Cozzens
- School of Public Health, University at Albany, State University of New York, Albany, New York
| | - David H Adams
- Department of Surgery, Mount Sinai Hospital, New York, New York
| | - Leonard Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Wechsler
- Department of Cardiothoracic Surgery, Drexel University, Philadelphia, Pennsylvania
| | - Thoralf M Sundt
- Cardiac Surgical Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Craig R Smith
- Department of Surgery, Columbia-Presbyterian Irving Medical Center, New York, New York
| | - Jeffrey P Gold
- Department of Administration, University of Nebraska Medical Center, Omaha, Nebraska
| | - Stephen J Lahey
- Division of Cardiothoracic Surgery, University of Connecticut, Storrs, Connecticut
| | - Desmond Jordan
- Department of Anesthesiology, Columbia-Presbyterian Irving Medical Center, New York, New York
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7
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Wang XW, Qu C, Huang C, Xiang XY, Lu ZQ. Minimally invasive direct coronary bypass compared with percutaneous coronary intervention for left anterior descending artery disease: a meta-analysis. J Cardiothorac Surg 2016; 11:125. [PMID: 27491539 PMCID: PMC4974706 DOI: 10.1186/s13019-016-0512-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 07/27/2016] [Indexed: 11/29/2022] Open
Abstract
Background The clinical outcomes for left anterior descending (LAD) coronary artery lesion between minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) are still controversial. The objective was to compare safety and efficacy between MIDCAB and PCI for LAD. Methods Electronic databases and article references were systematically searched to access relevant studies. End points included mortality, myocardial infarction, target vessel revascularization (TVR), major adverse coronary events (MACE), angina recurrence, and stroke. Results Fourteen studies with 941 patients were finally involved in the present study. The mortality and incidence of myocardial infarction were similar in MIDCAB and PCI groups at 30 days, 6 months, and at follow-up beyond 1 year. Compared with PCI, MIDCAB decreased incidence of TVR and MACE at 6 months and beyond 1 year follow-up. MIDCAB was associated with a lower incidence of angina recurrence at 6 months compared with PCI. PCI was associated with higher risk of restenosis in target vessel. No significant difference was shown for stroke. Conclusion Our meta-analysis indicates that there are no significant differences in the safety between MIDCAB and PCI in patients with LAD. However MIDCAB is superior to PCI for TVR and MACE.
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Affiliation(s)
- Xiao-Wen Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.,Department of Cardiothoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Can Qu
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Chun Huang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
| | - Xiao-Yong Xiang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Zhi-Qian Lu
- Department of Cardiothoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
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8
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Charytan DM, Desai M, Mathur M, Stern NM, Brooks MM, Krzych LJ, Schuler GC, Kaehler J, Rodriguez-Granillo AM, Hueb W, Reeves BC, Thiele H, Rodriguez AE, Buszman PP, Buszman PE, Maurer R, Winkelmayer WC. Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease. Kidney Int 2016; 90:411-421. [PMID: 27259368 DOI: 10.1016/j.kint.2016.03.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/02/2016] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
Abstract
Coronary atherosclerotic disease is highly prevalent in chronic kidney disease (CKD). Although revascularization improves outcomes, procedural risks are increased in CKD, and unbiased data comparing coronary artery bypass grafting (CABG) and percutaneous intervention (PCI) in CKD are sparse. To compare outcomes of CABG and PCI in stage 3 to 5 CKD, we identified randomized trials comparing these procedures. Investigators were contacted to obtain individual, patient-level data. Ten of 27 trials meeting inclusion criteria provided data. These trials enrolled 3993 patients encompassing 526 patients with stage 3 to 5 CKD of whom 137 were stage 3b-5 CKD. Among individuals with stage 3 to 5 CKD, mortality through 5 years was not different after CABG compared with PCI (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.67-1.46) or stage 3b-5 CKD (HR 1.29, CI 0.68-2.46). However, CKD modified the impact on survival free of myocardial infarction: it was not different between CABG and PCI for individuals with preserved kidney function (HR 0.97, CI 0.80-1.17), but was significantly lower after CABG in stage 3-5 CKD (HR 0.49, CI 0.29-0.82) and stage 3b-5 CKD (HR 0.23, CI 0.09-0.58). Repeat revascularization was reduced after CABG compared with PCI regardless, of baseline kidney function. Results were limited by unavailability of data from several trials and paucity of enrolled patients with stage 4-5 CKD. Thus, our patient-level meta-analysis of individuals with CKD randomized to CABG versus PCI suggests that CABG significantly reduces the risk of subsequent myocardial infarction and revascularization without affecting survival in these patients.
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Affiliation(s)
- David M Charytan
- Departments of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA.
| | - Manisha Desai
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Maya Mathur
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Noam M Stern
- Departments of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Maria M Brooks
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Lukasz J Krzych
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Medical University of Silesia, Katowice, Poland
| | | | - Jan Kaehler
- Department of Cardiology, Klinikum Herford, Herford, Germany
| | | | - Whady Hueb
- Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Holger Thiele
- University Heart Center Luebeck and German Heart Research Center (DZHK), Luebeck, Germany
| | - Alfredo E Rodriguez
- Cardiac Unit, Otamendi Hospital, Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Piotr P Buszman
- Silesian Center for Heart Diseases, Zabrze, Poland; American Heart of Poland, Katowice, Poland
| | | | - Rie Maurer
- Departments of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
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10
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Pölsterl S, Singh M, Katouzian A, Navab N, Kastrati A, Ladic L, Kamen A. Stratification of coronary artery disease patients for revascularization procedure based on estimating adverse effects. BMC Med Inform Decis Mak 2015; 15:9. [PMID: 25889930 PMCID: PMC4336731 DOI: 10.1186/s12911-015-0131-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 01/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) is the most commonly performed treatment for coronary atherosclerosis. It is associated with a higher incidence of repeat revascularization procedures compared to coronary artery bypass grafting surgery. Recent results indicate that PCI is only cost-effective for a subset of patients. Estimating risks of treatment options would be an effort toward personalized treatment strategy for coronary atherosclerosis. Methods In this paper, we propose to model clinical knowledge about the treatment of coronary atherosclerosis to identify patient-subgroup-specific classifiers to predict the risk of adverse events of different treatment options. We constructed one model for each patient subgroup to account for subgroup-specific interpretation and availability of features and hierarchically aggregated these models to cover the entire data. In addition, we deviated from the current clinical workflow only for patients with high probability of benefiting from an alternative treatment, as suggested by this model. Consequently, we devised a two-stage test with optimized negative and positive predictive values as the main indicators of performance. Our analysis was based on 2,377 patients that underwent PCI. Performance was compared with a conventional classification model and the existing clinical practice by estimating effectiveness, safety, and costs for different endpoints (6 month angiographic restenosis, 12 and 36 month hazardous events). Results Compared to the current clinical practice, the proposed method achieved an estimated reduction in adverse effects by 25.0% (95% CI, 17.8 to 30.2) for hazardous events at 36 months and 31.2% (95% CI, 25.4 to 39.0) for hazardous events at 12 months. Estimated total savings per patient amounted to $693 and $794 at 12 and 36 months, respectively. The proposed subgroup-specific method outperformed conventional population wide regression: The median area under the receiver operating characteristic curve increased from 0.57 to 0.61 for prediction of angiographic restenosis and from 0.76 to 0.85 for prediction of hazardous events. Conclusions The results of this study demonstrated the efficacy of deployment of bare-metal stents and coronary artery bypass grafting surgery for subsets of patients. This is one effort towards development of personalized treatment strategies for patients with coronary atherosclerosis that could significantly impact associated treatment costs. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0131-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sebastian Pölsterl
- Computer Aided Medical Procedures, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Germany.
| | - Maneesh Singh
- Siemens Corporation, Corporate Technology, Imaging and Computer Vision, 755 College Rd E, Princeton, NJ, USA
| | - Amin Katouzian
- Computer Aided Medical Procedures, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Lazarettstr. 36, 80636, München, Germany
| | - Lance Ladic
- Siemens Healthcare Diagnostics, Strategic Innovation Group, 511 Benedict Ave, Tarrytown, NY, USA
| | - Ali Kamen
- Siemens Corporation, Corporate Technology, Imaging and Computer Vision, 755 College Rd E, Princeton, NJ, USA
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Coronary Artery Bypass Graft Surgery Versus Drug-Eluting Stents for Patients With Isolated Proximal Left Anterior Descending Disease. J Am Coll Cardiol 2014; 64:2717-26. [DOI: 10.1016/j.jacc.2014.09.074] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 09/08/2014] [Accepted: 09/14/2014] [Indexed: 11/20/2022]
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Smit Y, Vlayen J, Koppenaal H, Eefting F, Kappetein AP, Mariani MA. Percutaneous coronary invervention versus coronary artery bypass grafting: a meta-analysis. J Thorac Cardiovasc Surg 2014; 149:831-8.e1-13. [PMID: 25467373 DOI: 10.1016/j.jtcvs.2014.10.112] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 10/17/2014] [Accepted: 10/25/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with coronary artery disease. METHODS MEDLINE, Embase, and Cochrane Central were searched, and randomized controlled trials were included. Outcomes were assessed at maximum available follow-up. RESULTS This meta-analysis includes 31 trials with 15,004 patients. As regards death, more patients died after PCI compared with CABG across all types of patients (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0-1.3; P = .05) as well as in patients with multivessel disease (OR, 1.2; 95% CI, 1.0-1.4; P = .02) or diabetes (OR, 1.6; 95% CI, 1.2-2.1; P < .01). Myocardial infarction occurred as frequently after PCI (OR, 1.2; 95% CI, 0.9-1.5; P = .28). Repeat revascularization was more common after PCI (OR, 4.5; 95% CI, 3.5-5.8; P < .01), with a progressive decline in ORs from the pre-stent era (OR, 7.0; 95% CI, 5.1-9.7; P < .01), to the bare metal stent era (OR, 4.5; 95% CI, 3.6-5.5; P < .01), and to the drug-eluting stent era (OR, 2.5; 95% CI, 1.8-3.4; P < .01). Stroke was more common after CABG (OR, 0.7; 95% CI, 0.5-0.9; P = .01). CONCLUSIONS Compared with PCI, CABG had a lower risk of death in multivessel disease or diabetes patients eligible for either intervention, a lower risk of repeat revascularization, but a higher risk of stroke.
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Affiliation(s)
- Yolba Smit
- Independent Researcher, Leuth, The Netherlands
| | | | | | - Frank Eefting
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Deppe AC, Liakopoulos OJ, Kuhn EW, Slottosch I, Scherner M, Choi YH, Rahmanian PB, Wahlers T. Minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for single-vessel disease: a meta-analysis of 2885 patients†. Eur J Cardiothorac Surg 2014; 47:397-406; discussion 406. [DOI: 10.1093/ejcts/ezu285] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Deo SV, Sharma V, Shah IK, Erwin PJ, Joyce LD, Park SJ. Minimally Invasive Direct Coronary Artery Bypass Graft Surgery or Percutaneous Coronary Intervention for Proximal Left Anterior Descending Artery Stenosis: A Meta-Analysis. Ann Thorac Surg 2014; 97:2056-65. [DOI: 10.1016/j.athoracsur.2014.01.086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/14/2014] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
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Sismanoglu M, Sarikaya S, Onk OA, Adademir T, Aksoy E, Kirali K. Treatment of left anterior descending coronary artery stenosis: stent or surgery. Asian Cardiovasc Thorac Ann 2014; 21:528-32. [PMID: 24570553 DOI: 10.1177/0218492312461262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drug-eluting stents have emerged as a solution to the problem of restenosis after bare-metal stent implantation, as an alternative to off-pump coronary bypass, for isolated left anterior descending coronary artery lesions at short-term follow-up. However, long-term follow-up is yet to be defined. METHODS From January to December 2004, 64 consecutive patients underwent myocardial revascularization: 31 by drug-eluting stents and 33 by off-pump coronary bypass. The primary endpoint was angiographic outcome, and the secondary endpoint was clinical outcome at 5 years. RESULTS There was no early or late mortality in either group. Hospital stay was significantly shorter in the stent group (2.5 ± 2.1 vs. 7.1 ± 4.9 days, p = 0.003). Long-term patency was higher and major adverse cardiac events (recurrence of angina and revascularization of target vessel) were encountered less frequently in the coronary bypass group, although not significantly. CONCLUSION The 5-year follow-up showed no significant difference between the off-pump coronary bypass and stent groups for the primary and secondary endpoints. As a significant difference between treatment options is lacking, decision-making for appropriate treatment in this group of patients requires the collaboration of cardiologists and cardiovascular surgeons and an individual approach, to achieve successful long-term outcomes.
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Affiliation(s)
- Mesut Sismanoglu
- Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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Zhang B, Zhou J, Li H, Zhou M, Chen A, Zhao Q. Minimally invasive direct coronary artery bypass reduces the need for repeated revascularization at long-term follow-up compared with stenting: A meta-analysis. Int J Cardiol 2013; 168:5469-71. [DOI: 10.1016/j.ijcard.2013.07.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/25/2013] [Indexed: 11/17/2022]
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Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery. JACC Cardiovasc Interv 2013; 6:20-6. [DOI: 10.1016/j.jcin.2012.09.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 09/27/2012] [Indexed: 11/22/2022]
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012. [PMID: 23182125 DOI: 10.1016/j.jacc.2012.07.013] [Citation(s) in RCA: 1225] [Impact Index Per Article: 102.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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19
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354-471. [PMID: 23166211 DOI: 10.1161/cir.0b013e318277d6a0] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1713] [Impact Index Per Article: 131.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 894] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 575] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 423] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Edelman JJ, Yan TD, Padang R, Bannon PG, Vallely MP. Off-Pump Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention: A Meta-Analysis of Randomized and Nonrandomized Studies. Ann Thorac Surg 2010; 90:1384-90. [PMID: 20868861 DOI: 10.1016/j.athoracsur.2010.04.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/08/2010] [Accepted: 04/09/2010] [Indexed: 11/29/2022]
Affiliation(s)
- J James Edelman
- Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Baird Institute, Faculty of Medicine, University of Sydney, Sydney, Australia
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Thiele H, Desch S, Falk V. Comparing MIDCAB surgery and stenting for isolated proximal left anterior descending stenosis. Interv Cardiol 2010. [DOI: 10.2217/ica.10.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Thiele H, Falk V. Coronary Artery Bypass Graft Versus Drug-Eluting Stent for High-Risk Proximal Left Anterior Descending Stenosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 12:36-45. [PMID: 20842480 DOI: 10.1007/s11936-009-0054-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kapoor JR, Gienger AL, Ardehali R, Varghese R, Perez MV, Sundaram V, McDonald KM, Owens DK, Hlatky MA, Bravata DM. Isolated Disease of the Proximal Left Anterior Descending Artery. JACC Cardiovasc Interv 2008; 1:483-91. [DOI: 10.1016/j.jcin.2008.07.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 07/10/2008] [Accepted: 07/27/2008] [Indexed: 11/27/2022]
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Shuhaiber J, Reston J. Time to intervention during cardiac interventions. Are we forgetting a confounder? Asian Cardiovasc Thorac Ann 2008; 16:1-3. [PMID: 18245695 DOI: 10.1177/021849230801600101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As we evolve in the field of contemporary cardiothoracic surgery and witness modern applications of new techniques and technology, we need to be careful of how statistical methods are executed. Publications with hidden mediators that are not adequately addressed can lead to biased conclusions, especially when meta-analyzed. Public health policies need to be sure that their statements are as unbiased as possible for correct inference, leading to optimal patient safety and well-being. Careful analysis of hidden mediators is important in studies comparing the effectiveness of procedures and devices. Such analysis is critical in identifying mediators such as waiting time that should be considered when constructing interventions to be evaluated in the next RCT. In particular, RCTs of devices and procedures should always conduct (and report) ITT analysis, capturing all events from the time of randomization forward to control for differential waiting time. Similarly, observational registries and databases should count time zero as the time when patients are first referred for therapy, rather than when they enter a hospital to receive treatment; this would ensure that events during the waiting period are captured.
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Meta-analysis comparing clinical effectiveness of drug-eluting stents, bare metal stents and coronary artery bypass surgery. INT J EVID-BASED HEA 2007. [DOI: 10.1097/01258363-200709000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Oh EH, Imanaka Y, Hayashida K, Kobuse H. Meta-analysis comparing clinical effectiveness of drug-eluting stents, bare metal stents and coronary artery bypass surgery. INT J EVID-BASED HEA 2007; 5:296-304. [PMID: 21631793 DOI: 10.1111/j.1479-6988.2007.00071.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective To compare clinical outcomes among patients receiving drug-eluting stents, bare metal stents, or coronary artery bypass grafting surgery (CABG) to treat coronary artery disease. Data sources Randomised controlled trials were systematically selected from electronic database for head-to-head comparisons. The results from these head-to-head comparisons were used for an adjusted indirect comparison. Methods Published randomised controlled trials were reviewed for outcome data in patients treated for coronary artery disease with drug-eluting stents, bare metal stents, or CABG. Head-to-head comparisons were conducted for drug-eluting stents versus bare metal stents and for CABG versus bare metal stents. Adjusted indirect comparison was used to compare drug-eluting stents and CABG. Mid-term clinical outcomes (range: 6-12 months) were investigated and included rates of mortality, myocardial infarction, thrombosis, target lesion revascularisation, target vessel revascularisation, restenosis and major adverse cardiac events. Results Systematic literature search identified 23 randomised controlled trials (15 for drug-eluting stents vs. bare metal stents, 8 for CABG vs. bare metal stents). Head-to-head comparisons for both single and multiple vessel disease demonstrated that compared with bare metal stents, drug-eluting stents had better outcomes for target lesion revascularisation, target vessel revascularisation, restenosis and major adverse cardiac events. Except target lesion revascularisation, data were similarly favourable for CABG when compared with bare metal stents. Adjusted indirect comparison between drug-eluting stents and CABG in single vessel disease failed to detect significant differences in any of the measured outcomes. Multiple vessel disease data analysis demonstrated that target vessel revascularisation (odds ratio 3.41 [95% CI 2.29-5.08]) and major adverse cardiac events (1.89 [1.28-2.79]) were superior to drug-eluting stents in patients undergoing CABG. Conclusions Drug-eluting stents and CABG were superior to bare metal stents in terms of target lesion revascularisation (drug-eluting stents only), target vessel revascularisation, restenosis and major adverse cardiac events. There was no difference in clinical outcomes when comparing CABG and drug-eluting stents in patients with single vessel disease, and CABG may be superior to drug-eluting stents for target vessel revascularisation and major adverse cardiac events in patients with multiple vessel disease. However, results may vary between subpopulations with different clinical or socioeconomic differences.
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Affiliation(s)
- Eun-Hwan Oh
- Department of Healthcare Economics and Quality Management, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Takagi H, Tanabashi T, Kawai N, Umemoto T. Minimally invasive direct coronary artery bypass versus percutaneous coronary stenting for stenosis of the left anterior descending artery. Eur J Cardiothorac Surg 2007; 32:400; author reply 400-1. [PMID: 17513117 DOI: 10.1016/j.ejcts.2007.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 03/29/2007] [Accepted: 04/19/2007] [Indexed: 11/20/2022] Open
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Bainbridge D, Cheng D, Martin J. Reply to the Editor. J Thorac Cardiovasc Surg 2007. [DOI: 10.1016/j.jtcvs.2007.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takagi H, Tanabashi T, Kawai N, Umemoto T. A meta-analysis of minimally invasive coronary artery bypass versus percutaneous coronary intervention with stenting for isolated left anterior descending artery disease is indispensable. J Thorac Cardiovasc Surg 2007; 134:548; author reply 548-9. [PMID: 17662827 DOI: 10.1016/j.jtcvs.2007.03.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 03/12/2007] [Indexed: 11/24/2022]
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Jaffery Z, Kowalski M, Weaver WD, Khanal S. A meta-analysis of randomized control trials comparing minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for stenosis of the proximal left anterior descending artery. Eur J Cardiothorac Surg 2007; 31:691-7. [PMID: 17300948 DOI: 10.1016/j.ejcts.2007.01.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 12/04/2006] [Accepted: 01/15/2007] [Indexed: 11/26/2022] Open
Abstract
Percutaneous intervention (PCI) and minimally invasive direct coronary bypass grafting (MIDCAB) are both well-accepted treatment options for isolated high-grade stenosis of proximal left anterior descending coronary artery. Small studies comparing the two modalities have yielded conflicting results. We performed a meta-analysis of randomized control trials to compare percutaneous intervention with minimally invasive coronary bypass grafting for isolated proximal left anterior descending artery stenosis. Five randomized trials with a total of 711 patients and average follow-up of 2.3 years were included in the analysis; 380 patients received stents and 331 underwent surgery. Only one trial used drug eluting stents. There were a small number of events overall in each trial. Difference between mortality was 12 events versus 15 between the PCI versus MIDCAB group. Similarly, the difference in myocardial infarction was 14 versus 10, and target vessel revascularization was 56 versus 19. The relative risk for stenting versus MIDCAB was 0.96 [(95% CI: 0.47, 1.99), p=0.92, I(2)=17.5%], for mortality and myocardial infarction, 0.77 [(95% CI: 0.30, 2.01), p=0.60, I(2)=10.4%] for mortality and 1.81 [(95% CI: 0.80, 4.06), p=0.15, I(2)=65.9%] for the composite end point of mortality, myocardial infarction and target vessel revascularization. Excluding the trial with drug eluting stents the relative risk for the composite outcome of mortality, myocardial infarction and target vessel revascularization was significantly higher for PCI [RR=2.27 (95% CI: 1.32, 3.90), p=0.003, I(2)=18.9%]. Overall mortality and myocardial infarction rates are similar for bare metal stents versus MIDCAB, but surgery was associated with significantly lower rates of repeat revascularization. The number of randomized patients and events were small. The effect of drug eluting stents might close the gap of repeat revascularization compared to MIDCAB for this disease.
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Affiliation(s)
- Zehra Jaffery
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 40202, USA
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