Abstract 16267: Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients Presenting With Acute Coronary Syndrome With Culprit Unprotected Left Main Artery

Abstract

Background: Outcomes of coronary artery bypass grafting (CABG) versus (vs) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndromes (ACS) with unprotected left main (ULM) as culprit vessel are not well represented in major clinical trials. We performed a meta-analysis and meta-regression of studies that compared the outcomes of CABG vs PCI in ULM in ACS. Methods: Medline, EmCare, CINHAL, Cochrane database, and Google Scholar were searched for studies comparing CABG vs PCI in patients who presented with ACS and was found to have ULM as culprit vessel. Our primary outcome was mortality at longest follow up. Our secondary Outcome was repeat revascularization at longest follow up. We used PM method with HKSJ adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using I 2 statistics. Multivariable meta-regression analysis was used to account for heterogeneity. History of smoking, diabetes, hypertension and previous PCI was used for multivariable regression. R version 3.6.2 was used for all statistical analysis. Results: A total of 8 studies met our inclusion criteria. The follow up period varied from 6 months to 10 years. There was no significant difference in the risk of mortality between CABG vs PCI; RR: 1.31, CI: 0.76 - 2.27, I 2 = 71%. However, the PCI as compared to CABG was associated with higher risk repeat revascularization at longest follow up; RR: 2.64, 95% CI: 1.56 to 4.46, I 2 = 60%. Meta-regression analysis reported previous PCI to be associated with lower mortality with CABG [P value =0.01], while history of diabetes was associated with higher mortality with CABG [P value <0.001]. Conclusion: CABG vs PCI in ULM in ACS is associated with similar risk of mortality. Previous PCI and non-diabetics were associated with higher mortality with PCI as compared to CABG. However PCI as compared to CABG was associated with higher risk of repeat revascularizations.