Percutaneous coronary intervention or coronary artery bypass graft surgery for left main coronary artery disease: A meta-analysis of randomized trials

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Left main coronary artery disease (LMCAD) is a critical condition requiring revascularization.
• Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are primary treatment options.
• Long-term comparative outcomes are essential for clinical decision-making.

Purpose of the Study:

• To compare long-term (≥5 years) outcomes of PCI versus CABG for LMCAD.
• To synthesize evidence from updated randomized controlled trials.
• To inform treatment strategies for LMCAD.

Main Methods:

• Meta-analysis of published randomized controlled trials.
• Inclusion of studies with a minimum follow-up of 5 years.
• Assessment of all-cause death, cardiovascular death, myocardial infarction, stroke, and repeat revascularization.

Main Results:

• No significant difference in the risk of all-cause death, cardiovascular death, myocardial infarction, or stroke between PCI and CABG.
• PCI was associated with significantly higher rates of repeat revascularization compared to CABG.
• Long-term outcomes suggest a trade-off between upfront risks and late procedural needs.

Conclusions:

• PCI and CABG offer comparable long-term survival and major adverse cardiovascular event rates for LMCAD.
• The higher need for repeat revascularization with PCI is a key consideration.
• Treatment decisions should balance CABG's initial risks with PCI's late revascularization burden, incorporating patient preferences.