Why the study?
Patients with unprotected left main disease treated with PCI have shown inconsistent results compared to those treated with CABG.
Does percutaneous coronary intervention reduce major adverse cardiovascular and cerebrovascular events in patients with unprotected left main coronary artery disease compared to coronary artery bypass grafting?
Does percutaneous coronary intervention reduce major adverse cardiovascular and cerebrovascular events in patients with unprotected left main coronary artery disease compared to coronary artery bypass grafting?
In patients with unprotected left main coronary artery disease, CABG reduces MACCEs primarily by decreasing target vessel revascularization, though PCI is associated with a lower risk of stroke.
Background: Patients with unprotected left main (UPLM) disease who underwent percutaneous coronary intervention (PCI) were found to have inconsistent results compared to those treated with coronary artery bypass grafting (CABG). Methods: We identified and enrolled randomized controlled trials (RCTs) and observational studies (OSs) comparing PCI versus CABG for UPLM disease. A meta-analysis was performed using Stata 17.0. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs). Additionally, all-cause death, cardiac death, myocardial infarction (MI), stroke, target vessel revascularization (TVR), and stent thrombosis (ST) were included as secondary endpoints. The odds ratios and 95% confidence intervals (CIs) were calculated. Sensitivity analyses were implemented if I2 > 50% or p < 0.01. Publication bias analysis was conducted if more than 10 studies were included. Results: A total of 5 RCTs and 18 OSs involving 35,409 patients were included. The CABG strategy had a significantly lower incidence of MACCEs, primarily due to TVR. A significantly lower stroke rate was observed with the PCI strategy, as well as a significantly lower all-cause death, cardiac death, MI, and ST rate compared with the CABG strategy. Conclusions: MACCE rates were significantly lower in patients who underwent CABG, primarily due to TVR, but stroke rates were higher. RCTs with different study types need further investigation to confirm the most effective strategy.
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Liu et al. (2024) studied this question.
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