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Percutaneous Coronary Intervention Versus Surgery in Left Main Stenosis-A Meta-Analysis and Systematic Review of

Safi U Khan1, Hammad Rahman1, Adeel Arshad2

  • 1Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA.

Heart, Lung & Circulation
|September 20, 2017
PubMed

Insights

Percutaneous coronary intervention (PCI) is safer for left main coronary artery disease initially, but coronary artery bypass graft (CABG) surgery shows better long-term results. Both treatments have comparable outcomes at one year.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Left main coronary artery (LMCA) disease poses significant risks.
  • Treatment decisions involve balancing procedural safety with long-term efficacy.
  • Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) are primary treatment options.

Purpose of the Study:

  • To compare the safety and efficacy of PCI versus CABG for LMCA disease.
  • To evaluate short-term and long-term clinical outcomes.
  • To assess periprocedural adverse events associated with each modality.

Main Methods:

  • Systematic review and meta-analysis of six randomized controlled trials (RCTs).
  • Searched major databases: PubMed/Medline, Embase, and Cochrane Library.
  • Pooled estimates using random effects model; reported binary outcomes as risk ratios (RR) and continuous outcomes as mean differences (MD) with 95% confidence intervals (CI).

Main Results:

  • 3794 patients were randomized; mean age 64.7 years, 74.4% male, mean Logistic EURO score (LES) 2.9.
  • PCI showed reduced major adverse cardiovascular events (MACE) at 30 days (RR: 0.55; 95% CI, 0.41-0.75) but similar MACE at 1 year (RR: 1.15; 95% CI, 0.92-1.45).
  • CABG demonstrated superior 5-year MACE rates (RR: 1.32; 95% CI, 1.13-1.53), driven by higher target vessel revascularization (TVR) and myocardial infarction (MI) with PCI. PCI was safer periprocedurally, with lower rates of MI, stroke, bleeding, and transfusion needs.

Conclusions:

  • PCI offers reduced MACE at 30 days and comparable MACE at 1 year compared to CABG for LMCA disease.
  • CABG is more effective for mid- to long-term outcomes, particularly in reducing TVR and MI.
  • PCI is a safer procedure concerning periprocedural adverse events, including MI, stroke, and bleeding.
Abstract

Keywords:
Coronary artery diseaseCoronary bypass surgeryCoronary revascularisationLeft main coronary arteryPercutaneous coronary intervention

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