Journal article
Coronary artery bypass graft surgery versus percutaneous coronary intervention with drug-eluting stents for left main coronary artery disease: A meta-analysis of randomized trials.
- Putzu A Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: alessandroputzu@ymail.com.
- Gallo M Department of Cardiac Surgery, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: michelegallo@hotmail.co.uk.
- Martino EA Department of Anesthesia and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza, Italy. Electronic address: enri.martino@gmail.com.
- Ferrari E Department of Cardiac Surgery, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: enrico.ferrari@cardiocentro.org.
- Pedrazzini G Department of Cardiology, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: giovanni.pedrazzini@cardiocentro.org.
- Moccetti T Department of Cardiology, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: tiziano.moccetti@cardiocentro.org.
- Cassina T Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: tiziano.cassina@cardiocentro.org.
- 2017-04-26
Published in:
- International journal of cardiology. - 2017
Cardiac anesthesia
Cardiac surgery
Left main coronary disease
Mortality
Percutaneous coronary intervention
Stroke
Coronary Artery Bypass
Coronary Artery Disease
Drug-Eluting Stents
Follow-Up Studies
Humans
Percutaneous Coronary Intervention
Postoperative Complications
Randomized Controlled Trials as Topic
Treatment Outcome
English
BACKGROUND
Despite several clinical studies, efficacy of coronary artery bypass grafting (CABG) surgery versus percutaneous coronary intervention (PCI) in patients with left main (LM) disease remains controversial. The objective of this meta-analysis of randomized trials was to evaluate the clinical outcome of CABG versus PCI with drug-eluting stents in LM coronary disease.
METHODS
We systematically searched online databases up to March 2017 for randomized trials comparing CABG to PCI with drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS
We included data from 5 randomized trials and 4595 patients. At 30days, CABG was associated with higher stroke (OR 2.54 [95% CI, 1.02-6.31]) and periprocedural myocardial infarction (OR 1.45 [95% CI, 1.00-2.10]), with no other significant differences compared to PCI. At 1year, CABG reduced repeat revascularization (OR 0.56 [95% CI, 0.40-0.77]), but increased stroke (OR 5.11 [95% CI, 1.62-16.12]). At 3-5years, CABG reduced repeat revascularization (OR 0.55 [95% CI, 0.45-0.67]) and non-periprocedural myocardial infarction (OR 0.45 [95% CI, 0.29-0.70]), without significant differences on other outcomes.
CONCLUSIONS
From the present updated meta-analysis of available studies on LM coronary disease treatment, there were no differences in mortality, myocardial infarction, and stroke rate at 3-5years follow-up after CABG or PCI, but CABG decreased the rate of repeat revascularization and non-periprocedural infarction. However, at short-term follow-up, CABG showed higher rate of stroke and periprocedural myocardial infarction, but these effects attenuated over time. These findings merit further investigation at longer follow-up.
Despite several clinical studies, efficacy of coronary artery bypass grafting (CABG) surgery versus percutaneous coronary intervention (PCI) in patients with left main (LM) disease remains controversial. The objective of this meta-analysis of randomized trials was to evaluate the clinical outcome of CABG versus PCI with drug-eluting stents in LM coronary disease.
METHODS
We systematically searched online databases up to March 2017 for randomized trials comparing CABG to PCI with drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS
We included data from 5 randomized trials and 4595 patients. At 30days, CABG was associated with higher stroke (OR 2.54 [95% CI, 1.02-6.31]) and periprocedural myocardial infarction (OR 1.45 [95% CI, 1.00-2.10]), with no other significant differences compared to PCI. At 1year, CABG reduced repeat revascularization (OR 0.56 [95% CI, 0.40-0.77]), but increased stroke (OR 5.11 [95% CI, 1.62-16.12]). At 3-5years, CABG reduced repeat revascularization (OR 0.55 [95% CI, 0.45-0.67]) and non-periprocedural myocardial infarction (OR 0.45 [95% CI, 0.29-0.70]), without significant differences on other outcomes.
CONCLUSIONS
From the present updated meta-analysis of available studies on LM coronary disease treatment, there were no differences in mortality, myocardial infarction, and stroke rate at 3-5years follow-up after CABG or PCI, but CABG decreased the rate of repeat revascularization and non-periprocedural infarction. However, at short-term follow-up, CABG showed higher rate of stroke and periprocedural myocardial infarction, but these effects attenuated over time. These findings merit further investigation at longer follow-up.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ijcard.2017.04.015
- PMID 28438354
- Persistent URL
- https://sonar.ch/global/documents/190126
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