Abstract
ObjectivesTo compare the safety and efficacy of percutaneous coronary intervention (PCI) using drug-eluting stent (DES) and coronary artery bypass graft (CABG) for the treatment of left main coronary artery (LMCA) disease.BackgroundSeveral new randomized trials have recently examined the clinical outcomes of PCI and CABG in LMCA disease. However, the results of these studies were inconsistent.Materials and MethodsWe searched five online electronic databases to identify all the randomized clinical trials assessing the outcomes of PCI using DES and CABG in patients with LMCA. The clinical outcomes were the major adverse cardiac and cerebrovascular event (MACCE), all-cause death, myocardial infarction (MI), stroke, and repeat revascularization (RR).ResultsA total of 5 randomized clinical trials with 4595 LMCA patients were included in this meta-analysis. For one year follow-up, the results indicated that PCI were associated with a lower risk of stroke (RR = 0.21, 95% CI = 0.07–0.65, P = 0.007), a higher risk of RR (RR = 1.72, 95% CI = 1.28–2.33, P < 0.001) than CABG. Moreover, for long-term follow-up, there were significant higher risks of MACCE and RR with PCI versus CABG (MACCE: HR = 1.26, 95% CI = 1.11–1.44, P = 0.001; RR: HR = 1.70, 95% CI = 1.42–2.05, P < 0.001). However, there were no significant differences between the two groups in all-cause death and MI risks, regardless of follow-up duration.ConclusionsPCI is noninferior to CABG in short term follow-up of patients with LMCA disease, but CABG is more safety and efficacy than PCI using DES in long-term follow-up.
Highlights
Left main coronary artery (LMCA) disease, one of obstructive coronary artery diseases, is diagnosed in 5–7% of patients who have been referred for coronary angiography [1, 2]
For one year follow-up, the results indicated that percutaneous coronary intervention (PCI) were associated with a lower risk of stroke (RR = 0.21, 95% confidence intervals (CIs) = 0.07–0.65, P = 0.007), a higher risk of risk ratios (RRs) (RR = 1.72, 95% CI = 1.28–2.33, P < 0.001) than coronary artery bypass graft (CABG)
PCI is noninferior to CABG in short term follow-up of patients with left main coronary artery (LMCA) disease, but CABG is more safety and efficacy than PCI using drug-eluting stent (DES) in long-term follow-up
Summary
Left main coronary artery (LMCA) disease, one of obstructive coronary artery diseases, is diagnosed in 5–7% of patients who have been referred for coronary angiography [1, 2]. Percutaneous coronary intervention (PCI) with stenting, a Class II alternative method of LMCA treatment www.impactjournals.com/oncotarget by current guidelined recommend, is becoming more used and shows favorable clinical outcomes for patients with significant LMCA disease that have a high risk of surgery and low or intermediated SYNTAX scores because of many remarkable improvements in medical device technology and adjunctive pharmacotherapies have been achieved during the last decade [8,9,10,11]. Randomized controlled clinical trials have compared the safety and efficacy of PCI using DES and CABG for the treatment of LMCA disease [14,15,16,17,18,19,20,21].
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