Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery
Zhenzhen Wang1, Biming Zhan1, Huihui Bao1
1Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Insights
Percutaneous coronary intervention (PCI) with stents shows reduced stroke risk compared to coronary artery bypass graft surgery (CABG) for unprotected left main stenosis. CABG leads to fewer long-term complications, while PCI is safe and effective short-term.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Unprotected left main coronary artery (UPLM) stenosis is a critical condition requiring revascularization.
- Percutaneous coronary intervention (PCI) with stents and coronary artery bypass graft surgery (CABG) are primary treatment options.
- Comparative outcomes between PCI and CABG for UPLM stenosis require ongoing evaluation.
Purpose of the Study:
- To conduct a meta-analysis comparing PCI with stents versus CABG for UPLM stenosis.
- To evaluate key clinical outcomes including mortality, stroke, myocardial infarction, and revascularization rates.
- To inform treatment decisions based on comparative efficacy and safety profiles.
Main Methods:
- Systematic literature search of Cochrane Library, PubMed, and EMBASE databases up to July 2017.
- Inclusion of randomized and prospective trials assessing PCI versus CABG for UPLM stenosis.
- Quality assessment using the Newcastle-Ottawa scale; pooled analysis of 19 studies with 16,900 participants.
Main Results:
- No significant differences in all-cause mortality (OR 0.94) or cardiac death (OR 1.04) between PCI and CABG.
- PCI demonstrated significantly lower stroke rates in both short-term (OR 0.45) and long-term (OR 0.36) follow-up.
- PCI was associated with higher risks of myocardial infarction (OR 1.59), repeat revascularization (OR 2.47), and target vessel revascularization (OR 2.10).
Conclusions:
- PCI significantly reduces the risk of stroke compared to CABG, making it a preferred option for high-stroke-risk patients.
- PCI is safe and effective in the short term for UPLM patients, with a notable reduction in 30-day mortality.
- CABG is associated with fewer long-term complications, suggesting a potential benefit for durable outcomes.
Background:
The present study performed a meta-analysis of randomized and prospective trials to compare the outcomes of percutaneous coronary intervention (PCI) with stents versus coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (UPLM) stenosis.
Methods:
The Cochrane Library, PubMed and EMBASE databases were systematically searched until July 2017. The Newcastle-Ottawa scale was used for quality assessment.
Results:
A total of 19 studies with 16,900 participants were included. Pooled analysis showed no significant differences in all-cause mortality (odds ratio [OR] 0.94; 95% CI 0.74-1.20) and cardiac death (OR 1.04; 95% CI 0.74-1.47). However, subgroup analysis showed that PCI was associated with a low all-cause mortality rate at 30-day follow up (OR 0.48; 95% CI 0.26-0.89). The stroke rate in PCI was lower in short-term follow up (OR 0.45; 95% CI 0.23-0.88) and long-term follow up (OR 0.36; 95% CI 0.27-0.47). On the other hand, PCI was associated with higher risk of myocardial infarction (OR 1.59; 95% CI 1.34-1.88), repeat revascularization (OR 2.47; 95% CI 1.80-3.37) and target vessel revascularization (OR 2.10; 95% CI 1.72-2.57) compared to CABG in the pooled analysis.
Conclusions:
The current evidence suggests that the risk of stroke was significantly reduced in PCI compared to that in CABG. Therefore, PCI is the preferred treatment for patients with a high risk of stroke. Additionally, in short-term follow up, PCI was reported to be safe and effective for UPLM patients compared to CABG. However, CABG caused fewer complications long term.
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