Long-Term Outcomes of Patients with Unprotected Left Main Coronary Artery Disease Treated with Percutaneous Angioplasty versus Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials.

Gani Bajraktari,Ibadete Bytyçi,Zarife Rexhaj,Fjolla Zhubi-Bakija,Artan Bajraktari,Fernando Alfonso,Michael Y Henein,Gjin Ndrepepa,Afrim Poniku,Shpend Elezi

doi:10.3390/jcm9072231

Abstract

Background and Aim: Treatment of patients with left main coronary artery disease (LMCA) with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The aim of this meta-analysis was to compare the long-term clinical outcomes of patients with unprotected LMCA treated randomly by PCI or CABG. Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov database searches identified five randomized trials (RCTs) including 4499 patients with unprotected LMCA comparing PCI (n = 2249) vs. CABG (n = 2250), with a minimum clinical follow-up of five years. Random effect risk ratios were used for efficacy and safety outcomes. The study was registered in PROSPERO. The primary outcome was major adverse cardiac events (MACE), defined as a composite of death from any cause, myocardial infarction or stroke. Results: Compared to CABG, patients assigned to PCI had a similar rate of MACE (risk ratio (RR): 1.13; 95% CI: 0.94 to 1.36; p = 0.19), myocardial infarction (RR: 1.48; 95% CI: 0.97 to 2.25; p = 0.07) and stroke (RR: 0.87; 95% CI: 0.62 to 1.23; p = 0.42). Additionally, all-cause mortality (RR: 1.07; 95% CI: 0.89 to 1.28; p = 0.48) and cardiovascular (CV) mortality (RR: 1.13; 95% CI: 0.89 to 1.43; p = 0.31) were not different. However, the risk of any repeat revascularization (RR: 1.70; 95% CI: 1.34 to 2.15; p < 0.00001) was higher in patients assigned to PCI. Conclusions: The findings of this meta-analysis suggest that the long-term survival and MACE of patients who underwent PCI for unprotected LMCA stenosis were comparable to those receiving CABG, despite a higher rate of repeat revascularization.

Highlights

The available evidence supporting the treatment of patients with left main coronary artery disease (LMCA) in support of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains unascertained
The main findings at a median follow-up of eight years can be summarized as follows: (1) There was no significant difference in the occurrence of major adverse cardiac events (MACE), all-cause mortality, cardiac death, myocardial infarction and stroke between patients assigned to PCI compared with those assigned to a CABG treatment strategy
In keeping with previous publications [18,19] in the same field, our results showed that the long-term efficacy of PCI for treating unprotected LMCA disease is similar to CABG, with similar rates of MACE and secondary clinical outcomes, even all-cause and cardiovascular mortality

Summary

Introduction

The available evidence supporting the treatment of patients with left main coronary artery disease (LMCA) in support of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains unascertained. Treatment of patients with left main coronary artery disease (LMCA) with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The aim of this meta-analysis was to compare the long-term clinical outcomes of patients with unprotected LMCA treated randomly by PCI or CABG. Conclusions: The findings of this meta-analysis suggest that the long-term survival and MACE of patients who underwent PCI for unprotected LMCA stenosis were comparable to those receiving CABG, despite a higher rate of repeat revascularization

Methods

Results

Conclusion