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Long‐term follow‐up of percutaneous coronary intervention versus coronary artery bypass grafting in left main coronary artery disease: A systematic review and meta‐analysis
Author(s) -
Garg Aakash,
Rout Amit,
Raheja Hitesh,
Hakeem Hisham,
Sharma Samin
Publication year - 2021
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.29338
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , cardiology , myocardial infarction , meta analysis , coronary artery disease , revascularization , stroke (engine) , left main coronary artery disease , odds ratio , randomized controlled trial , mechanical engineering , engineering
Objectives We conducted a systematic review and meta‐analysis to evaluate the long‐term outcomes of PCI compared to CABG in patients with LMCAD. Background Recent data from randomized controlled trials (RCTs) has raised concerns regarding the long‐term efficacy and safety of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD). Methods We searched MEDLINE and EMBASE databases for published RCTs comparing PCI using stenting with CABG in patients with LMCAD. Preferred reporting items for systematic review and meta‐analysis guidelines were used for the present study. End‐points of interest were all‐cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), stroke, and repeat revascularization at longest available follow‐up. Relevant data were collected and pooled odds ratio (OR) with 95% confidence intervals (CI) was calculated using random‐effects model. Results Five RCTs including a total of 4,499 patients were included in the final analysis. Mean duration of follow‐up was 96 months. The risks of all‐cause mortality [OR 1.09 (95% CI 0.88–1.34)] and cardiovascular mortality [1.14 (0.88–1.47)] were comparable between PCI and CABG. There were no statistically significant differences between PCI and CABG for MI [1.52 (0.98–2.37)] and stroke [0.84 (0.48–1.45)]. Conversely, repeat revascularization was significantly higher with PCI as compared with CABG [1.82 (1.49–2.22)]. Conclusion At long‐term follow‐up, PCI is associated with similar risks of mortality but a higher risk of repeat revascularization compared with CABG in LMCAD. Long‐term risk of MI with PCI compared to CABG needs to be further explored in future studies.