Percutaneous coronary intervention versus bypass surgery for left main coronary artery disease: a meta-analysis of
Giuseppe Ferrante1, Patrizia Presbitero, Marco Valgimigli
1Department of Interventional Cardiology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy. giu.ferrante@hotmail.it
Insights
Percutaneous coronary intervention (PCI) is comparable to coronary artery bypass grafting (CABG) for unprotected left main coronary artery stenosis (ULMCA). While PCI reduced stroke risk, it increased repeat revascularization needs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Unprotected left main coronary artery stenosis (ULMCA) is a critical condition requiring revascularization.
- Both percutaneous coronary intervention (PCI) with stent implantation and coronary artery bypass grafting (CABG) are treatment options.
Purpose of the Study:
- To compare the efficacy and safety of PCI versus CABG for ULMCA treatment.
- To evaluate clinical outcomes at 12-month follow-up.
Main Methods:
- A meta-analysis of four randomized trials involving 1,611 patients.
- Data were analyzed using odds ratios (OR) with 95% confidence intervals (CI).
Main Results:
- PCI significantly reduced stroke risk compared to CABG (OR 0.14, 95% CI [0.04 to 0.55]).
- PCI was associated with an increased risk of repeat revascularization (OR 2.17, 95% CI [1.48 to 3.17]).
- Mortality and myocardial infarction rates were similar between PCI and CABG.
Conclusions:
- PCI and CABG demonstrate comparable effectiveness for ULMCA treatment regarding major adverse cardiac or cerebrovascular events at 12 months.
- The choice between PCI and CABG may depend on balancing stroke risk reduction against the need for repeat revascularization.
Aims:
We performed a meta-analysis of randomised trials comparing percutaneous coronary intervention (PCI) with stent implantation to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis (ULMCA).
Methods And Results:
Pubmed and other databases were searched. Data were expressed as odds ratios (OR) with 95% confidence interval (CI). Four randomised trials enrolling 1,611 patients were selected. At 12-month follow-up PCI, as compared to CABG, was associated with a significant risk reduction of stroke (0.12% vs. 1.90%, OR 0.14, 95% CI [0.04 to 0.55], p=0.004), with an increased risk of repeat revascularisation (11.03% vs. 5.45%, OR 2.17, 95% CI [1.48 to 3.17], p <0.001), a similar risk of mortality (OR 0.72, 95% CI [0.42 to 1.24], p=0.23) or myocardial infarction (OR 0.97, 95% CI [0.54 to 1.74], p=0.91), leading to an increased risk of major adverse cardiovascular events (14.37% vs. 10.14%, OR 1.50, 95% CI [1.10 to 2.04], p=0.01) and similar hazard of major adverse cardiac or cerebrovascular events (14.49% vs. 12.04%, OR 1.24, 95% CI [0.93 to 1.67], p=0.15).
Conclusions:
PCI is comparable to CABG for the treatment of ULMCA with respect to the composite of major adverse cardiovascular or cerebrovascular events at 12-month follow-up.
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