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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Meta-Analysis Comparing Percutaneous Coronary Revascularization Using Drug-Eluting Stent Versus Coronary Artery
Kongyong Cui1, Dongfeng Zhang1, Shuzheng Lyu1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Insights
Coronary artery bypass grafting (CABG) is superior to drug-eluting stents (DES) for patients with left ventricular systolic dysfunction. CABG reduces mortality and myocardial infarction risk compared to DES in this vulnerable population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left ventricular (LV) systolic dysfunction poses challenges for revascularization strategies.
- The comparative safety and efficacy of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) in these patients remain debated.
Purpose of the Study:
- To conduct a meta-analysis identifying the optimal revascularization strategy for patients with coronary artery disease and LV systolic dysfunction.
- To compare all-cause mortality, cardiac mortality, myocardial infarction, repeat revascularization, and stroke rates between PCI with DES and CABG.
Main Methods:
- Comprehensive meta-analysis of adjusted observational studies published between January 2003 and March 2018.
- Inclusion of 8 studies with 10,268 patients.
- Utilized random-effect modeling to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for primary endpoint of all-cause death.
Main Results:
- PCI with DES was associated with significantly higher risks of all-cause mortality (HR 1.36), cardiac mortality (HR 2.20), myocardial infarction (HR 1.69), and repeat revascularization (HR 4.95) compared to CABG.
- Similar outcomes were observed in subgroups with LV ejection fraction <35% or left main/multivessel disease.
- Stroke rates were comparable between the two interventions (HR 0.92).
Conclusions:
- Coronary artery bypass grafting (CABG) demonstrates superior outcomes compared to percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with coronary artery disease and LV systolic dysfunction.
- CABG is particularly advantageous for patients with severe LV systolic dysfunction or complex coronary anatomy (left main and/or multivessel disease).
- These findings suggest CABG as the preferred revascularization strategy for this high-risk patient group.
Abstract:
The relative safety and efficacy of percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and coronary artery bypass grafting (CABG) in patients with left ventricular (LV) systolic dysfunction remains controversial; therefore we conducted this meta-analysis to identify the optimal strategy for such cohorts. A comprehensive search of the electronic databases including PubMed, EMBASE, and Cochrane Library from January 1, 2003 to March 1, 2018 was performed to identify the eligible adjusted observational studies. The primary end point was all-cause death during the longest follow-up, and the generic inverse variance random-effect model was used to estimate the pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Eight adjusted observational studies involving 10,268 patients were included. Compared with CABG, PCI with DES was associated with higher risk of all-cause mortality (HR 1.36, 95% CI 1.16 to 1.60), cardiac mortality (HR 2.20, 95% CI 1.63 to 2.95), myocardial infarction (HR 1.69, 95% CI 1.28 to 2.24), and repeat revascularization (HR 4.95, 95% CI 3.28 to 7.46) in patients with coronary artery disease and LV systolic dysfunction. Besides, separate analysis of patients with LV ejection fraction <35% or left main and/or multivessel disease obtained similar results compared with the overall analysis. However, DES and CABG shared similar rates of stroke (HR 0.92, 95% CI 0.67 to 1.26). In conclusion, CABG appears to be superior to PCI with DES for patients with coronary artery disease and LV systolic dysfunction, particularly in patients with severe LV systolic dysfunction or those with left main and/or multivessel disease.
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