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Drug‐eluting stent placement versus coronary artery bypass surgery for unprotected left main coronary artery disease: A meta‐analysis of randomized controlled trials
Author(s) -
Upadhaya Sunil,
Baniya Ramkaji,
Madala Seetharamprasad,
Subedi Suresh Kumar,
Khan Jahangir,
Velagapudi Ravi Kanth,
Bachuwa Ghassan
Publication year - 2017
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13090
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , cardiology , myocardial infarction , randomized controlled trial , stroke (engine) , odds ratio , coronary artery disease , drug eluting stent , subgroup analysis , revascularization , coronary artery bypass surgery , stent , confidence interval , artery , mechanical engineering , engineering
BACKGROUND Coronary artery bypass grafting (CABG) is the standard of care for treating left main coronary lesions. However, recently published randomized controlled trials (RCT) have shown conflicting results. We sought to compare clinical outcomes of percutaneous coronary intervention (PCI) with drug‐eluting stent placement to CABG using a meta‐analysis of randomized controlled trials. METHODS A systemic search of Pubmed, Scopus, Cochrane library, and Clinicaltrials.gov was performed for randomized controlled trials comparing PCI with CABG in patients with left main stenosis. Data were analyzed using random effect models and Mantel‐Haenszel methods. The primary outcome was major adverse cardiovascular and cerebral events (MACCE). The secondary outcomes were myocardial infarction, stroke, cardiac, and all‐cause mortality. A subgroup analysis based on SYNTAX score was also performed. RESULTS A total of 4595 patients (2297 in the PCI group and 2298 in the CABG group) from five RCTs were included in the analysis. There were significant differences in MACCE (odds ratio [OR] 1.36, confidence interval [CI] 95%, 1.18‐1.58, p‐value: < 0.0001) and repeat revascularization (OR 1.85, CI 95%, 1.53‐2.23, p‐value: < 0.00001) favoring CABG. There were no significant differences in the incidence of myocardial infarction, stroke, or cardiac and all‐cause mortality. Based on SYNTAX score, CABG was superior in terms of MACCE only in the subgroup with SYNTAX score of 33 or more. CONCLUSIONS CABG results in fewer MACCE and need for repeat revascularization than PCI in patients with unprotected left main disease.