Percutaneous coronary intervention versus coronary artery bypass graft for left main coronary artery disease: A
Michele Gallo1, David Blitzer2, Pietro L Laforgia3
1Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland.
Insights
Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) show similar mortality for left main disease. However, PCI increases myocardial infarction and repeat revascularization risk at 5 years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left main coronary artery disease (LMCD) treatment strategies remain debated.
- Optimal revascularization for LMCD is critical for patient outcomes.
Purpose of the Study:
- To compare percutaneous coronary intervention (PCI) with drug-eluting stents versus coronary artery bypass graft (CABG) for LMCD.
- To evaluate mortality, myocardial infarction (MI), stroke, and revascularization rates.
Main Methods:
- Systematic review and meta-analysis of randomized trials up to January 2020.
- Included 4595 patients across 5 trials comparing PCI with drug-eluting stents and CABG.
- Analyzed outcomes at 30 days, 1 year, and 5 years using fixed-effects models.
Main Results:
- At 5 years, PCI showed higher rates of MI (OR, 1.43) and repeat revascularization (OR, 1.89) compared to CABG.
- PCI was associated with lower periprocedural MI but higher nonperiprocedural MI at 5 years.
- No significant difference in 5-year mortality or stroke rates between PCI and CABG.
Conclusions:
- Neither PCI nor CABG demonstrates superior 5-year mortality for LMCD.
- CABG had higher early stroke rates, while PCI led to increased MI and repeat revascularization at 5 years.
Background:
The optimal revascularization strategy for patients with left main coronary artery disease is still controversial. This is systematic review and meta-analysis aims to evaluate the outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents compared with coronary artery bypass graft (CABG) for LM disease.
Methods:
Online electronic databases were systematically reviewed until January 2020 for randomized trials comparing PCI with drug-eluting stents and CABG. Primary outcomes were: all-cause mortality, myocardial infarction (MI), stroke, and repeated revascularization. Secondary outcomes included periprocedural and nonperiprocedural MI. The period of follow-up included 30 days, 1 year, and 5 years. Odds ratio and 95% confidence interval were calculated with a fixed-effects model.
Results:
A total of 4595 patients (5 randomized trials) with left main coronary artery disease were included. At 30 days and 1 year, PCI was associated with lower incidence of stroke, higher repeated revascularization, and similar odds of mortality and MI compared with CABG. At 5 years, PCI was associated with higher rates of MI (odds ratio, 1.43; 95% confidence interval, 1.13-1.79; P = .003) and repeat revascularization (odds ratio, 1.89; 95% CI, 1.58-2.26; P < .001) than CABG. PCI was associated with lower periprocedural MI at 30 days, whereas at 5 years PCI was associated with higher nonperiprocedural MI (odds ratio, 2.32; 95% confidence interval, 1.62-3.31; P < .001). Mortality and stroke rate did not differ at 5-year follow-up.
Conclusions:
Patients with left main coronary artery disease treated with either PCI or CABG do not show significant difference in early or 5-year mortality. Although CABG was associated with higher stroke rates at 30 days and 1 year, PCI was associated with an increase in MI and need for repeat revascularization at 5 years.
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