Cirugía de revascularización miocárdica versus stent farmacoactivos en pacientes con enfermedad de tronco común izquierdo: una revisión sistemática de ensayos clínicos aleatorizados y de metaanálisis de ensayos clínicos aleatorizados

Abstract

ObjectiveThe aim of this systematic review is to analyze in the literature the clinical results of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention with drug-eluting stents in patients with left main stem disease. MethodsWe carried out a literature search using Pubmed, Google Scholar, Medline, Embase and Cochrane databases. We limited our search to randomized controlled trials or meta-analyses carried out on randomized controlled trials, with no year of publication or language restriction. ResultsEighty-two articles were found using the search methodology described. Of these, 14 articles were selected: 7 papers from 5 randomized non-inferiority clinical trials (SYNTAX, PRECOMBAT, study by Boudriot et al., NOBLE and EXCEL) and 7 meta-analyses. These trials have compared first generation drug-eluting stents (SYNTAX: stent with paclitaxel; Boudriot et al. and PRECOMBAT: stent with sirolimus) and second-generation drug-eluting stents (NOBLE: stent with biolimus; EXCEL: stent with cobalt-chromium everolimus) with CABG.With reference to the coronary revascularization procedure, bilateral internal mammary artery use ranged from 7.4% to 54.4%. All the included randomized trials reported a lower rate of repeated revascularization in the surgical population. According to the meta-analyses review, the risk, expressed as odds ratio, of requiring a new myocardial revascularization procedure by the percutaneous population compared with that one of the surgical population, ranged from 1.68 to 2.21. ConclusionsIndependently from the type of drug eluting stent used in the percutaneous procedures and despite low rate of bilateral internal mammary artery used in the surgical group, the risk of requiring a new myocardial revascularization procedure by the percutaneous population was twice that one of the surgical population.