Drug-eluting stents versus coronary artery bypass grafting for left-main coronary artery disease

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Left-main coronary artery disease (LMCAD) is a critical condition requiring revascularization.
• Both percutaneous coronary intervention with drug-eluting stents (DES-PCI) and coronary artery bypass grafting (CABG) are established treatment options for LMCAD.
• Comparative outcomes between DES-PCI and CABG for LMCAD remain an area of active research.

Purpose of the Study:

• To compare the long-term follow-up outcomes of DES-PCI versus CABG in patients with LMCAD.
• To evaluate differences in mortality, myocardial infarction (MI), stroke, and repeat revascularization (RRV) between the two treatment modalities.

Main Methods:

• A comprehensive meta-analysis was conducted, including randomized controlled trials (RCTs) and observational studies with propensity-score analysis.
• Literature search was performed across MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to November 2016.
• Pooled analysis utilized random-effects models to combine study-specific estimates of hazard ratios (HRs) for key clinical outcomes.

Main Results:

• The meta-analysis included 5 RCTs and 17 observational studies, totaling 12,387 patients.
• DES-PCI was associated with a significant increase in the composite of death, MI, and RRV (HR, 1.42; P < 0.00001).
• Significant increases in any RRV (HR, 1.86), target-vessel RRV (HR, 3.28), and target-lesion RRV (HR, 2.26) were observed with DES-PCI compared to CABG.

Conclusions:

• While DES-PCI did not show significant differences in mortality, MI, or stroke compared to CABG for LMCAD, it was associated with higher rates of repeat revascularization.
• The findings suggest that CABG may offer advantages in reducing the need for repeat procedures in LMCAD patients.
• Further research may be warranted to refine patient selection and optimize treatment strategies for LMCAD.