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Percutaneous coronary intervention or coronary artery bypass grafting for unprotected left main coronary artery disease
Author(s) -
Mahmoud Ahmed N.,
Elgendy Islam Y.,
Mentias Amgad,
Saad Marwan,
Ibrahim Walid,
Mojadidi Mohammad K.,
Nairooz Ramez,
Eshtehardi Parham,
David Anderson R.,
Samady Habib
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26970
Subject(s) - medicine , percutaneous coronary intervention , conventional pci , cardiology , myocardial infarction , relative risk , stroke (engine) , coronary artery disease , revascularization , surgery , confidence interval , mechanical engineering , engineering
Background Recent trials comparing PCI with CABG for unprotected left main disease yielded discrepant evidence. Objectives To perform an updated meta‐analysis of randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease. Methods Randomized trials comparing PCI versus CABG for patients with unprotected left main coronary artery disease were included. Summary estimates risk ratios (RRs) were performed with a DerSimonian and Laird model at short‐term, intermediate and long‐term follow‐up periods (i.e., 30‐days, 1‐year, and >1‐year). Outcomes evaluated were major adverse cardiac and cerebrovascular events (MACCE), all‐cause mortality, myocardial infarction, stroke, revascularization and stent thrombosis or symptomatic graft occlusion. Results Six trials with 4,700 patients and a mean SYNTAX score of 23 were included. At short‐term follow‐up, the risk of MACCE was lower with PCI (RR 0.55, 95% confidence interval [CI] 0.39‐0.76) driven by the lower risk of myocardial infarction (RR 0.67, 95% CI 0.46‐0.99), and stroke (RR 0.38, 95% CI 0.16‐0.90). The risk of MACCE was similar at the intermediate follow‐up (RR 1.21, 95% CI 0.97‐1.51). At long‐term follow‐up, PCI was associated with a higher risk of MACCE (RR 1.19, 95% CI 1.01‐1.41), due to a higher risk of revascularization (RR 1.62, 95% CI 1.34‐1.94), while the risk of all‐cause mortality, myocardial infarction, and stroke were similar. Conclusions In patients with unprotected left main coronary disease and low to intermediate SYNTAX score, PCI might be an acceptable alternative to CABG. © 2017 Wiley Periodicals, Inc.