Long‐term follow‐up of percutaneous coronary intervention versus coronary artery bypass grafting in left main coronary artery disease: A systematic review and meta‐analysis. Issue 3 (26th October 2020)

• Record Type: Journal Article
• Authors: Garg, Aakash; Rout, Amit; Raheja, Hitesh; Hakeem, Hisham; Sharma, Samin
• Is Part Of: Catheterization and cardiovascular interventions. Volume 98:Issue 3(2021)
• Page Start: 427
• Page End: 433
• Publication Date: 2020-10-26
• Subjects: coronary artery bypass grafting -- left main coronary artery disease -- long‐term follow‐up -- percutaneous coronary intervention; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29338
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: We conducted a systematic review and meta‐analysis to evaluate the long‐term outcomes of PCI compared to CABG in patients with LMCAD. Background: Recent data from randomized controlled trials (RCTs) has raised concerns regarding the long‐term efficacy and safety of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD). Methods: We searched MEDLINE and EMBASE databases for published RCTs comparing PCI using stenting with CABG in patients with LMCAD. Preferred reporting items for systematic review and meta‐analysis guidelines were used for the present study. End‐points of interest were all‐cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), stroke, and repeat revascularization at longest available follow‐up. Relevant data were collected and pooled odds ratio (OR) with 95% confidence intervals (CI) was calculated using random‐effects model. Results: Five RCTs including a total of 4, 499 patients were included in the final analysis. Mean duration of follow‐up was 96 months. The risks of all‐cause mortality [OR 1.09 (95% CI 0.88–1.34)] and cardiovascular mortality [1.14 (0.88–1.47)] were comparable between PCI and CABG. There were no statistically significant differences between PCI and CABG for MI [1.52 (0.98–2.37)] and stroke [0.84 (0.48–1.45)]. Conversely, repeat revascularization was significantly higher with PCI as compared with CABG [1.82 (1.49–2.22)]. Conclusion: At long‐term follow‐up, PCI is associated with similar risks of mortality but a higher risk of repeat revascularization compared with CABG in LMCAD. Long‐term risk of MI with PCI compared to CABG needs to be further explored in future studies.