Major cardiovascular events at 5 years in surgical versus percutaneous revascularization for left main stem disease:...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

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

Purpose of the Study:

• To analyze the incidence of major adverse cardiovascular events (MACE) in patients with left main stem disease treated with CABG versus PCI.
• To incorporate 5-year follow-up data from major clinical trials.

Main Methods:

• Meta-analysis of five manuscripts reporting 5-year results from four trials (SYNTAX, PRECOMBAT, NOBLE, EXCEL).
• Comparison of MACE, overall mortality, cardiac mortality, and stroke between CABG and PCI groups.
• Analysis using both protocol and universal definitions for myocardial infarction.

Main Results:

• CABG significantly reduced MACE compared to PCI (risk ratio = 0.74; 95% CI = 0.68-0.80) using the protocol definition for myocardial infarction.
• The benefit of CABG in reducing MACE was amplified using the universal definition for myocardial infarction (risk ratio = 0.70; 95% CI = 0.63-0.76).
• No significant differences were observed in overall mortality, cardiac mortality, or stroke risk between the two treatment groups.

Conclusions:

• CABG offers a significant reduction in MACE for patients with left main stem disease.
• The use of the universal definition for myocardial infarction highlights a greater advantage of CABG over PCI in long-term outcomes.
• CABG remains a superior revascularization strategy for left main stem disease concerning MACE reduction.