Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis

Joint Authors

Alraies, M. Chadi
Mukhtar, Maryam
Ullah, Waqas
Sattar, Yasar
Ullah, Irfan
Susheela, Ammu
Mamas, Mamas A.
Fischman, David L.

Source

Journal of Interventional Cardiology

Issue

Vol. 2020, Issue 2020 (31 Dec. 2020), pp.1-8, 8 p.

Publisher

Hindawi Publishing Corporation

Publication Date

2020-07-26

Country of Publication

Egypt

No. of Pages

8

Main Subjects

Diseases

Abstract EN

Background.

The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial.

Methods.

Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components.

A random effect model was used to compute an unadjusted odds ratio (OR).

Results.

A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified.

The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42–0.76; p = 0.0002) and all-cause mortality (OR, 0.52; 95% CI, 0.30–0.91; p = 0.02) was significantly lower in the PCI group.

There was no significant difference in the rate of myocardial infarction (MI) (p = 0.17) and revascularization (p = 0.12).

At 5 years, CABG was favored due to a significantly lower rate of MACCE (OR, 1.67; 95% CI, 1.18–2.36; p = <0.04), MI (OR, 1.67; 95% CI, 1.35–2.06; p = <0.00001), and revascularization (OR, 2.80; 95% CI, 2.18–3.60; p = <0.00001), respectively.

PCI was associated with a lower overall rate of a stroke, while the risk of all-cause mortality was not significantly different between the two groups at 1- (p = 0.75), 5- (p = 0.72), and 10-years (p = 0.20).

The Kaplan–Meier curve reconstruction revealed substantial variations over time; the 5-year incidence of MACCE was 38% with CABG, significantly lower than 45% with PCI (p = <0.00001).

Conclusion.

PCI might offer early safety advantages, while CABG provides greater durability in terms of lower long-term risk of ischemic events.

There appears to be an equivalent risk for all-cause mortality.

American Psychological Association (APA)

Ullah, Waqas& Sattar, Yasar& Ullah, Irfan& Susheela, Ammu& Mukhtar, Maryam& Alraies, M. Chadi…[et al.]. 2020. Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis. Journal of Interventional Cardiology،Vol. 2020, no. 2020, pp.1-8.
https://search.emarefa.net/detail/BIM-1187772

Modern Language Association (MLA)

Ullah, Waqas…[et al.]. Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis. Journal of Interventional Cardiology No. 2020 (2020), pp.1-8.
https://search.emarefa.net/detail/BIM-1187772

American Medical Association (AMA)

Ullah, Waqas& Sattar, Yasar& Ullah, Irfan& Susheela, Ammu& Mukhtar, Maryam& Alraies, M. Chadi…[et al.]. Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis. Journal of Interventional Cardiology. 2020. Vol. 2020, no. 2020, pp.1-8.
https://search.emarefa.net/detail/BIM-1187772

Data Type

Journal Articles

Language

English

Notes

Includes bibliographical references

Record ID

BIM-1187772