Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and
Waqas Ullah1, Yasar Sattar2, Irfan Ullah3
1Abington Jefferson Health, Abington, PA, USA.
Insights
Percutaneous coronary intervention (PCI) shows early safety benefits for stable left main coronary artery disease, while coronary artery bypass grafting (CABG) offers better long-term durability against ischemic events. All-cause mortality risk is similar between PCI and CABG.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- The optimal revascularization strategy for stable left main coronary artery disease (LMCAD) is debated.
- Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are primary treatment options.
Purpose of the Study:
- To compare the safety and efficacy of PCI versus CABG in patients with stable LMCAD.
- To evaluate major adverse cardiovascular and cerebrovascular events (MACCE) and mortality rates between the two treatment modalities.
Main Methods:
- A systematic literature search was conducted across digital databases.
- Meta-analysis using a random effect model to compute unadjusted odds ratios (OR) for MACCE and its components.
- Included 43 studies with 29,187 patients (13,709 PCI, 15,478 CABG).
Main Results:
- At 30 days, PCI demonstrated significantly lower rates of MACCE (OR, 0.56) and all-cause mortality (OR, 0.52).
- At 5 years, CABG showed significantly lower rates of MACCE (OR, 1.67), myocardial infarction (MI) (OR, 1.67), and revascularization (OR, 2.80).
- PCI was associated with lower stroke rates; all-cause mortality did not differ significantly at 1, 5, or 10 years. 5-year MACCE incidence was 38% for CABG vs. 45% for PCI.
Conclusions:
- PCI offers potential early safety advantages in treating stable LMCAD.
- CABG provides superior long-term durability, evidenced by reduced ischemic events.
- All-cause mortality risk appears equivalent between PCI and CABG in the long term.
Background:
The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial.
Methods:
Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components. A random effect model was used to compute an unadjusted odds ratio (OR).
Results:
A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42-0.76; p = 0.0002) and all-cause mortality (OR, 0.52; 95% CI, 0.30-0.91; p = 0.02) was significantly lower in the PCI group. There was no significant difference in the rate of myocardial infarction (MI) (p = 0.17) and revascularization (p = 0.12). At 5 years, CABG was favored due to a significantly lower rate of MACCE (OR, 1.67; 95% CI, 1.18-2.36; p = <0.04), MI (OR, 1.67; 95% CI, 1.35-2.06; p = <0.00001), and revascularization (OR, 2.80; 95% CI, 2.18-3.60; p = <0.00001), respectively. PCI was associated with a lower overall rate of a stroke, while the risk of all-cause mortality was not significantly different between the two groups at 1- (p = 0.75), 5- (p = 0.72), and 10-years (p = 0.20). The Kaplan-Meier curve reconstruction revealed substantial variations over time; the 5-year incidence of MACCE was 38% with CABG, significantly lower than 45% with PCI (p = <0.00001).
Conclusion:
PCI might offer early safety advantages, while CABG provides greater durability in terms of lower long-term risk of ischemic events. There appears to be an equivalent risk for all-cause mortality.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:24Cardiac Catheterization III: Left Heart Catheterization
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Angina IV: Management
01:26Mitral Stenosis III: Medical Management