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

Aakash Garg, Amit Rout, Hitesh Raheja, Hisham Hakeem, Samin Sharma

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)427-433
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume98
Issue number3
DOIs
StatePublished - Sep 2021

Keywords

  • coronary artery bypass grafting
  • left main coronary artery disease
  • long-term follow-up
  • percutaneous coronary intervention

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