Yuhan Chen
Visiting MD/PhD Student
Last active: 9/11/2017

Percutaneous intervention versus coronary artery bypass graft surgery in left main coronary artery stenosis: a systematic review and meta-analysis.

Zhang XL, Zhu QQ, Yang JJ, Chen YH, Li Y, Zhu SH, Xie J, Wang L, Kang LN, Xu B
BMC Med. 2017 15 (1): 84

PMID: 28427392 · PMCID: PMC5399381 · DOI:10.1186/s12916-017-0853-1

BACKGROUND - The optimal revascularization technique in patients with left main coronary artery disease (CAD) remains controversial. We aimed to compare the long-term performance of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in treatment of left main CAD.

METHODS - PubMed, EMBASE, and the Cochrane Library were searched until November 16, 2016.

RESULTS - Six randomized controlled trials and 22 matched observational studies including 22,487 patients and 90,167 patient-years of follow-up were included. PCI was associated with an overall higher risk for the major adverse cardiac and cerebrovascular events (hazard ratio (HR), 1.42; 95% confidence interval (CI), 1.14-1.77), mainly driven by higher rates of myocardial infarction (HR, 1.69; 95% CI, 1.22-2.34) and revascularization (HR, 2.80; 95% CI, 1.86-4.22). The overall risks for all-cause death (HR, 1.05; 95% CI, 0.93-1.20), cardiac death (HR, 1.05; 95% CI, 0.69-1.59), stroke (HR, 0.64; 95% CI, 0.33-1.24), and the composite safety endpoint of death, myocardial infarction, or stroke (HR, 1.06; 95% CI, 0.97-1.16) were similar between PCI and CABG. Stratified analysis based on stent types showed that the increased risk for myocardial infarction associated with PCI was only evident in patients with bare-metal stents or early-generation drug-eluting stents (DES), but not newer-generation DES. Stratified analyses based on study designs showed largely similar findings with the overall analyses, except for a significantly higher incidence of myocardial infarction in adjusted studies (HR, 2.01; 95% CI, 1.64-2.45) but a trend toward higher incidence in randomized trials (HR, 1.39; 95% CI, 0.85-2.27) associated with PCI.

CONCLUSIONS - Compared with CABG, PCI with newer-generation DES might be a safe alternative revascularization strategy for treatment of left main CAD, but is associated with more repeat revascularization.

MeSH Terms (11)

Coronary Artery Bypass Coronary Artery Disease Coronary Stenosis Drug-Eluting Stents Humans Incidence Myocardial Infarction Percutaneous Coronary Intervention Proportional Hazards Models Stroke Treatment Outcome

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