Bypass surgery versus percutaneous coronary intervention for the treatment of unprotected left main disease. A
S Desch1, E Boudriot, A Rastan
1Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Strümpellstrasse 39, Leipzig, Germany. stdesch@web.de
Insights
Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) show similar risks for death and heart attack in left main disease. CABG increases stroke risk, while PCI raises the need for repeat procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Unprotected left main coronary artery stenosis is a critical condition.
- Coronary artery bypass grafting (CABG) is the established standard treatment.
- Percutaneous coronary intervention (PCI) is emerging as a viable alternative.
Purpose of the Study:
- To compare the efficacy and safety of CABG versus PCI for de novo unprotected left main disease.
- To evaluate major adverse cardiac and cerebrovascular events (MACCE) between the two revascularization strategies.
Main Methods:
- Meta-analysis of 4 randomized controlled trials involving 1,611 patients.
- Comparison of outcomes including all-cause death, myocardial infarction, stroke, and repeat revascularization.
- Follow-up duration ranged from 1 to 2 years.
Main Results:
- No significant difference in the risk of death or myocardial infarction between CABG and PCI.
- PCI was associated with a significantly lower risk of stroke (RR 0.26, p=0.007).
- PCI showed a significantly higher risk of repeat revascularization (RR 1.94, p<0.001).
Conclusions:
- CABG and PCI offer comparable risks for death and myocardial infarction in unprotected left main disease.
- CABG is associated with a higher risk of stroke.
- PCI requires a higher rate of repeat revascularization.
Objective:
We performed a meta-analysis of randomized controlled trials to compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for the treatment of de novo unprotected left main disease.
Background:
Although CABG is accepted to be standard of care for revascularization of unprotected left main stenosis, PCI is increasingly being used as an alternative primary approach.
Methods:
We searched for randomized, controlled trials comparing CABG and PCI for the treatment of unprotected left main disease. Major adverse cardiac and cerebrovascular events (all-cause death, myocardial infarction, stroke, and repeat revascularization) were analyzed.
Results:
The search strategy identified 4 randomized controlled trials enrolling a total of 1,611 patients. Follow-up ranged between 1 and 2 years. There were no significant differences in the risk of death or myocardial infarction between the two treatment modalities. While the risk of stroke was significantly lower in patients undergoing PCI (risk ratio (RR) 0.26, 95% confidence interval (CI) 0.10-0.69, p = 0.007), the risk of repeat revascularization was higher among patients undergoing PCI (RR 1.94, 95% CI 1.43-2.61, p < 0.001). No relevant statistical heterogeneity across studies could be found.
Conclusion:
In this largest series of randomized patients with unprotected left main stenosis to date, the risk of death and myocardial infarction was comparable between CABG and PCI. However, patients undergoing CABG had a higher risk of stroke, whereas patients undergoing PCI were at a higher risk for repeat revascularization.
More Related Videos
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:24Cardiac Catheterization III: Left Heart Catheterization
01:26Mitral Stenosis III: Medical Management
01:27Coronary Artery Disease V: Interprofessional Care
01:26Angina IV: Management
01:26Atherosclerosis III: Management