Objective
To investigate the safety and efficacy of percutaneous coronary interventions (PCI)
versus coronary artery bypass graft (CABG) surgery for left main coronary artery (LMCA)
disease.
Methods
Six randomised controlled trials (RCTs) were reviewed by searching PubMed/Medline,
Embase and the Cochrane Library. Estimates were pooled according to random effects
model. Binary outcomes were reported as risk ratio (RR) and continuous outcomes were
reported as mean difference (MD) with 95% confidence interval (CI).
Results
3794 patients were randomised into PCI and CABG arms. Mean age of the total population
was 64.7 years, 74.4% were male and mean Logistic EURO score (LES) was 2.9. When compared
with CABG, patients treated with PCI had reduced risk of major adverse cardiovascular
events (MACE) at 30 days: (RR: 0.55; 95% CI, 0.41–0.75; p < 0.001; I2 = 0) but similar risk at 1 year (RR: 1.15; 95% CI, 0.92–1.45; p = 0.22; I2 = 0). Five years MACE rates favoured CABG (RR: 1.32; 95% CI, 1.13–1.53; p < 0.001; I2 = 0) driven by a higher rate of target vessel revascularisation (TVR) (RR: 1.71; 95%CI,
1.38–2.12; p < 0.001; I2 = 0) and myocardial infarction (MI) (RR: 1.97; 95%CI, 1.28–3.04; p < 0.001; I2 = 22). Percutaneous coronary intervention was comparatively a safer procedure with lower
rates of periprocedural adverse events including MI, stroke, bleeding events and need
for blood transfusions.
Conclusion
Percutaneous coronary intervention reduced MACE at 30 days with comparable MACE at 1 year. However, CABG was a more effective modality when considering mid- to long-term
outcomes. PCI is a safer procedure with regards to periprocedural adverse events.
KeyWords
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Article info
Publication history
Published online: August 25, 2017
Accepted:
August 4,
2017
Received in revised form:
July 18,
2017
Received:
April 10,
2017
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
