Long-Term Outcomes of Patients with Unprotected Left Main Coronary Artery Disease Treated with Percutaneous Angioplasty versus Bypass Grafting : A Meta-Analysis of Randomized Controlled Trials
| Autor: | Zarife Rexhaj, Afrim Poniku, Michael Y. Henein, Shpend Elezi, Gjin Ndrepepa, Fjolla Zhubi-Bakija, Artan Bajraktari, Fernando Alfonso, Gani Bajraktari, Ibadete Bytyçi |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment lcsh:Medicine Review 030204 cardiovascular system & hematology law.invention Coronary artery disease 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law coronary artery bypass graft Internal medicine medicine Cardiac and Cardiovascular Systems 030212 general & internal medicine Myocardial infarction cardiovascular diseases Stroke unprotected left main Kardiologi business.industry lcsh:R percutaneous coronary intervention Percutaneous coronary intervention General Medicine medicine.disease Relative risk Conventional PCI Cardiology business Mace coronary artery disease |
| Zdroj: | Journal of Clinical Medicine Journal of Clinical Medicine, Vol 9, Iss 2231, p 2231 (2020) |
| Popis: | Background and Aim: Treatment of patients with left main coronary artery disease (LMCA) with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The aim of this meta-analysis was to compare the long-term clinical outcomes of patients with unprotected LMCA treated randomly by PCI or CABG. Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov database searches identified five randomized trials (RCTs) including 4499 patients with unprotected LMCA comparing PCI (n = 2249) vs. CABG (n = 2250), with a minimum clinical follow-up of five years. Random effect risk ratios were used for efficacy and safety outcomes. The study was registered in PROSPERO. The primary outcome was major adverse cardiac events (MACE), defined as a composite of death from any cause, myocardial infarction or stroke. Results: Compared to CABG, patients assigned to PCI had a similar rate of MACE (risk ratio (RR): 1.13; 95% CI: 0.94 to 1.36; p = 0.19), myocardial infarction (RR: 1.48; 95% CI: 0.97 to 2.25; p = 0.07) and stroke (RR: 0.87; 95% CI: 0.62 to 1.23; p = 0.42). Additionally, all-cause mortality (RR: 1.07; 95% CI: 0.89 to 1.28; p = 0.48) and cardiovascular (CV) mortality (RR: 1.13; 95% CI: 0.89 to 1.43; p = 0.31) were not different. However, the risk of any repeat revascularization (RR: 1.70; 95% CI: 1.34 to 2.15; p < 0.00001) was higher in patients assigned to PCI. Conclusions: The findings of this meta-analysis suggest that the long-term survival and MACE of patients who underwent PCI for unprotected LMCA stenosis were comparable to those receiving CABG, despite a higher rate of repeat revascularization. |
| Databáze: | OpenAIRE |
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