Percutaneous coronary intervention vs. coronary artery bypass grafting for left main revascularization: an updated meta-analysis
| Autor: | Peter Marogil, Navkaranbir S. Bajaj, Nirav Patel, Garima Arora, Pankaj Arora, Ashwanikumar Bhardwaj, Rajat Kalra |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Coronary Artery Disease 030204 cardiovascular system & hematology Revascularization law.invention 03 medical and health sciences Coronary artery bypass surgery Percutaneous Coronary Intervention 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Coronary Artery Bypass Stroke business.industry Health Policy Percutaneous coronary intervention Drug-Eluting Stents Original Articles medicine.disease Coronary Vessels Treatment Outcome surgical procedures operative Relative risk Conventional PCI Cardiology Stents Cardiology and Cardiovascular Medicine business |
| Popis: | Aims The optimal revascularization strategy for left main coronary artery disease (LMD) remains controversial, especially with two recent randomized controlled trials showing conflicting results. We sought to address this controversy with our analysis. Methods and results Comprehensive literature search was performed. We compared percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for LMD revascularization using standard meta-analytic techniques. A 21% higher risk of long-term major adverse cardiac and cerebrovascular event [MACCE; composite of death, myocardial infarction (MI), stroke, and repeat revascularization] was observed in patients undergoing PCI in comparison with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05–1.40]. This risk was driven by higher rate of repeat revascularization in those undergoing PCI (RR 1.61, 95% CI 1.34–1.95). On the contrary, MACCE rates at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI 0.39–0.76), which was driven by lower rates of stroke in the PCI arm (RR 0.41, 95% CI 0.17–0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI 0.08–0.59) in the PCI arm were balanced by higher repeat revascularization rates in those undergoing PCI (RR 1.78, 95% CI 1.33–2.37), resulting in a clinical equipoise in MACCE rates between the two revascularization strategies. There was no difference in death or MI between PCI when compared with CABG at any time point. Conclusion Outcomes of CABG vs. PCI for LMD revascularization vary over time. Therefore, individualized decisions need to be made for LMD revascularization using the heart team approach. |
| Databáze: | OpenAIRE |
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