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Review
. 2020 Jul 14;9(7):2231.
doi: 10.3390/jcm9072231.

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

Gani Bajraktari  1   2   3 , Fjolla Zhubi-Bakija  2 , Gjin Ndrepepa  4 , Fernando Alfonso  5 , Shpend Elezi  3 , Zarife Rexhaj  2 , Ibadete Bytyçi  1   2 , Artan Bajraktari  1 , Afrim Poniku  2   3 , Michael Y Henein  1
Affiliations
Review

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

Gani Bajraktari et al. J Clin Med. .

Abstract

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.

Keywords: coronary artery bypass graft; coronary artery disease; percutaneous coronary intervention; unprotected left main.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) study selection flow chart. PCI: percutaneous coronary intervention and CABG: coronary artery bypass grafting.
Figure 2
Figure 2
Risk of major adverse cardiac events (MACE) at the latest follow-up: PCI vs. CABG.
Figure 3
Figure 3
Risk of all-cause mortality at the latest follow-up: PCI vs. CABG.
Figure 4
Figure 4
Risk of cardiovascular mortality at latest follow-up: PCI vs. CABG.
Figure 5
Figure 5
Risk of stroke at the latest follow-up: PCI vs. CABG.
Figure 6
Figure 6
Risk of myocardial infarction at the latest follow-up: PCI vs. CABG.
Figure 7
Figure 7
Risk of repeat revascularization at the latest follow-up: PCI vs. CABG.
See this image and copyright information in PMC

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