Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis
Background. The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial. Methods. Digital databases were searched to compare the major adverse cardiovascular and cerebrova...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2020/4081642 |
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| author | Waqas Ullah Yasar Sattar Irfan Ullah Ammu Susheela Maryam Mukhtar M. Chadi Alraies Mamas A. Mamas David L. Fischman |
| author_facet | Waqas Ullah Yasar Sattar Irfan Ullah Ammu Susheela Maryam Mukhtar M. Chadi Alraies Mamas A. Mamas David L. Fischman |
| author_sort | Waqas Ullah |
| collection | DOAJ |
| description | Background. The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial. Methods. Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components. A random effect model was used to compute an unadjusted odds ratio (OR). Results. A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42–0.76; p = 0.0002) and all-cause mortality (OR, 0.52; 95% CI, 0.30–0.91; p = 0.02) was significantly lower in the PCI group. There was no significant difference in the rate of myocardial infarction (MI) (p = 0.17) and revascularization (p = 0.12). At 5 years, CABG was favored due to a significantly lower rate of MACCE (OR, 1.67; 95% CI, 1.18–2.36; p = <0.04), MI (OR, 1.67; 95% CI, 1.35–2.06; p = <0.00001), and revascularization (OR, 2.80; 95% CI, 2.18–3.60; p = <0.00001), respectively. PCI was associated with a lower overall rate of a stroke, while the risk of all-cause mortality was not significantly different between the two groups at 1- (p = 0.75), 5- (p = 0.72), and 10-years (p = 0.20). The Kaplan–Meier curve reconstruction revealed substantial variations over time; the 5-year incidence of MACCE was 38% with CABG, significantly lower than 45% with PCI (p = <0.00001). Conclusion. PCI might offer early safety advantages, while CABG provides greater durability in terms of lower long-term risk of ischemic events. There appears to be an equivalent risk for all-cause mortality. |
| format | Article |
| id | doaj-art-fc3c6ab4ac5342babc44fc9fa3ec30eb |
| institution | Kabale University |
| issn | 0896-4327 1540-8183 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj-art-fc3c6ab4ac5342babc44fc9fa3ec30eb2025-02-03T06:06:29ZengWileyJournal of Interventional Cardiology0896-43271540-81832020-01-01202010.1155/2020/40816424081642Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-AnalysisWaqas Ullah0Yasar Sattar1Irfan Ullah2Ammu Susheela3Maryam Mukhtar4M. Chadi Alraies5Mamas A. Mamas6David L. Fischman7Abington Jefferson Health, Abington, PA, USAIcahn School of Medicine, New York, NY, USAKabir Medical College, Peshawar, PakistanLoyola Medical Center, Hines, IL, USARawalpindi Institute of Cardiology, Rawalpindi, PakistanDetroit Medical Center, Detroit, MI, USAKeele Cardiovascular Research Group, Keele University, Keele, Royal Stoke Hospital, UKThomas Jefferson University, Philadelphia, PA, USABackground. The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial. Methods. Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components. A random effect model was used to compute an unadjusted odds ratio (OR). Results. A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42–0.76; p = 0.0002) and all-cause mortality (OR, 0.52; 95% CI, 0.30–0.91; p = 0.02) was significantly lower in the PCI group. There was no significant difference in the rate of myocardial infarction (MI) (p = 0.17) and revascularization (p = 0.12). At 5 years, CABG was favored due to a significantly lower rate of MACCE (OR, 1.67; 95% CI, 1.18–2.36; p = <0.04), MI (OR, 1.67; 95% CI, 1.35–2.06; p = <0.00001), and revascularization (OR, 2.80; 95% CI, 2.18–3.60; p = <0.00001), respectively. PCI was associated with a lower overall rate of a stroke, while the risk of all-cause mortality was not significantly different between the two groups at 1- (p = 0.75), 5- (p = 0.72), and 10-years (p = 0.20). The Kaplan–Meier curve reconstruction revealed substantial variations over time; the 5-year incidence of MACCE was 38% with CABG, significantly lower than 45% with PCI (p = <0.00001). Conclusion. PCI might offer early safety advantages, while CABG provides greater durability in terms of lower long-term risk of ischemic events. There appears to be an equivalent risk for all-cause mortality.http://dx.doi.org/10.1155/2020/4081642 |
| spellingShingle | Waqas Ullah Yasar Sattar Irfan Ullah Ammu Susheela Maryam Mukhtar M. Chadi Alraies Mamas A. Mamas David L. Fischman Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis Journal of Interventional Cardiology |
| title | Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis |
| title_full | Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis |
| title_fullStr | Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis |
| title_short | Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis |
| title_sort | percutaneous intervention or bypass graft for left main coronary artery disease a systematic review and meta analysis |
| url | http://dx.doi.org/10.1155/2020/4081642 |
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