Title

Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary Intervention With Drug-Eluting Stents versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease.

Publication/Presentation Date

3-2017

Abstract

Few randomized controlled trials (RCTs) and observational studies had shown acceptable short-term efficacy and safety of percutaneous coronary intervention (PCI) with drug eluting stents (DES) as compared to coronary artery bypass grafting (CABG) in selected patients with left main coronary artery disease (LMCAD). We aimed to evaluate long-term outcomes of PCI using DES compared with CABG in patients with LMCAD. On November 1st, 2016, we searched available databases for published RCTs directly comparing DES PCI with CABG in patients with LMCAD. Odds ratios (OR) were used as the metric of choice for treatment effects using a random-effects models. I-squared index was used to assess heterogeneity across trials. Pre-specified end-points were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke and repeat revascularization at maximal available follow-up. We identified 5 RCTs including a total of 4,595 patients, with a median follow-up of 60 months. The risk of all-cause mortality [OR 1.01; 95% CI 0.76-1.34] and cardiovascular mortality [OR 1.02; 95% CI 0.73-1.42] were comparable between PCI with DES and CABG. Similarly, there were no statistically significant differences between PCI with DES and CABG for MI [OR 1.45; 95% CI 0.87-2.40] and stroke [OR 0.87; 95% CI 0.38-1.98]. Conversely, repeat revascularization was significantly higher with PCI as compared with CABG [OR 1.82; 95% CI 1.51-2.21]. In conclusion, in patients with LMCAD, PCI with DES appears to be a viable alternative to CABG at long-term follow-up, with similar risks of ischemic adverse events (mortality, MI and stroke) but a higher risk of repeat revascularization.

Volume

119

Issue

12

First Page

1942

Last Page

1948

Disciplines

Medicine and Health Sciences

PubMedID

28433215

Department(s)

Department of Medicine, Cardiology Division, Department of Medicine Fellows and Residents

Document Type

Article