Long-term outcomes of percutaneous or surgical treatment in left main disease
Juan G Chiabrando1,2, Giovanni M Vescovo3, Marco Lombardi4,5
1Interventional Cardiology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina - juan.chiabrando@hospitalitaliano.org.ar.
Insights
Long-term studies comparing percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) for left main coronary artery disease show similar survival rates. However, PCI is linked to higher rates of major adverse cardiovascular events and revascularization procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Long-term data comparing surgical (CABG) and percutaneous (PCI) treatments for left main coronary artery disease (LMCA) are limited.
- Understanding the comparative efficacy and safety of these revascularization strategies is crucial for clinical decision-making.
Purpose of the Study:
- To systematically review and meta-analyze randomized clinical trials comparing PCI and CABG for LMCA disease.
- To assess the long-term efficacy and safety of both treatment modalities.
Main Methods:
- Systematic search of PubMed, Google Scholar, Medline, and reference lists for relevant randomized clinical trials up to April 2020.
- Inclusion of 6 studies with data from 5812 patients, analyzed for major adverse cardiovascular events (MACE), revascularization, all-cause death, myocardial infarction (MI), and stroke.
- Mean follow-up duration of 6.7 years.
Main Results:
- PCI was associated with a significantly higher risk of MACE (IRR 1.24) and coronary revascularization (IRR 1.69) compared to CABG.
- No statistically significant differences were observed between PCI and CABG for all-cause death (IRR 1.06), MI (IRR 1.35), or stroke (IRR 0.66).
Conclusions:
- Long-term survival is comparable between PCI and CABG for LMCA disease.
- PCI demonstrates a higher incidence of MACE and the need for revascularization compared to CABG.
Introduction:
Long-term efficacy and safety of either surgical or percutaneous treatment left main coronary artery disease treatment is lacking.
Evidence Acquisition:
We conducted a systematic review and meta-analysis of the most updated randomized clinical trials that compared the efficacy of coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the Left Main Coronary Artery (LMCA) disease. It was also conducted a systematic search of PubMed, Google Scholar, reference lists of relevant articles, and Medline. The search utilized the following terms: "left main PCI versus CABG," "drug-eluting stents," "bypass surgery" and "left main stenting." The search of articles compatible with our inclusion and exclusion criteria was performed from inception through April 2020 and returned a combined total of 304 articles.
Evidence Synthesis:
We identified 6 studies, providing data on 5812 patients. The mean follow-up was 6.7 years. PCI was associated with an increased risk of major vascular events (MACE) (IRR 1.24, 95% CI [1.03-1.67], P<0.01), and coronary revascularization (IRR 1.69, 95% CI [1.42-2.03], P<0.01) compared to CABG. Furthermore, all-cause death, MI and stroke events were not statistically different between the two therapeutic revascularization methodologies (IRR 1.06, 95% CI [0.90-1.24], P=0.47, IRR 1.35, 95% CI [0.84-2.16], P=0.03 and IRR 0.66, 95% CI [0.43-1.01], P=0.05, respectively).
Conclusions:
LMCA PCI has an overall same survival compared to CABG in the long term follow-up. Nevertheless, MACE and revascularization events were more frequent in PCI compared to CABG.
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