What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Unprotected left main (ULM) stenosis (n=4394). Intervention: Coronary artery bypass graft (CABG) vs. Percutaneous coronary intervention (PCI). Primary outcome: All-cause death (OR 0.93, 95% CI 0.71-1.21, p=0.58).

What question did this study set out to answer?

To compare 5-year clinical outcomes and survival between percutaneous coronary intervention and coronary artery bypass grafting in patients with unprotected left main coronary artery stenosis.

May 4, 2020European Heart Journal - Quality of Care and Clinical OutcomesOpen Access

Percutaneous vs. surgical revascularization for patients with unprotected left main stenosis: a meta-analysis of 5-year follow-up randomized controlled trials

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Key result

Coronary artery bypass grafting showed no significant difference in 5-year all-cause mortality compared to percutaneous coronary intervention in patients with unprotected left main stenosis (OR 0.93).

Why the study?

Five-year survival of patients with unprotected left main stenosis according to the choice of percutaneous versus surgical revascularization remained to be defined.

Does percutaneous coronary intervention compared to coronary artery bypass graft reduce all-cause death at 5 years in patients with unprotected left main stenosis?

Key Points

To compare 5-year clinical outcomes and survival between percutaneous coronary intervention and coronary artery bypass grafting in patients with unprotected left main coronary artery stenosis.
Meta-analysis of 4 randomized controlled trials comprising 4,394 patients (2,197 treated with CABG, 657 with first-generation stents, and 1,540 with last-generation stents) with at least 5 years of follow-up.
Evaluated primary endpoint of all-cause mortality alongside secondary endpoints including cardiovascular death, stroke, myocardial infarction (MI), repeat revascularization, and MACCE, stratified by stent generation, age, and SYNTAX score (<32 vs. ≥33).
At 5 years, all-cause death did not differ between PCI and CABG (OR 0.93, 95% CI 0.71–1.21), with similar risks observed for cardiovascular death and stroke.
CABG significantly reduced 5-year MACCE (OR 0.69, 95% CI 0.60–0.79), primarily driven by lower rates of myocardial infarction (OR 0.48, 95% CI 0.36–0.65) and repeat revascularization (OR 0.53, 95% CI 0.45–0.64).
The MACCE benefit of CABG persisted across SYNTAX scores (OR 0.76, 95% CI 0.59–0.97 for <32; OR 0.63, 95% CI 0.47–0.84 for ≥33) and was evident in older patients (OR 0.65, 95% CI 0.51–0.84), but not in younger patients (OR 0.83, 95% CI 0.65–1.07).

Study Design

Type

Meta-Analysis (n=4,394)

Structured PICO

Does percutaneous coronary intervention compared to coronary artery bypass graft reduce all-cause death at 5 years in patients with unprotected left main stenosis?

Population

4,394 patients with unprotected left main stenosis from 4 randomized controlled trials comparing PCI versus CABG, followed for at least 5 years.

Intervention

Percutaneous coronary intervention (PCI) using first-generation or last-generation coronary stents

Comparator

Coronary artery bypass graft (CABG)

Outcome

All-cause death at 5 yearshard clinical

Main Result

Odds Ratio: 0.93 (95% CI 0.71–1.21)

p-value: p=0.58

Limitations

Individual-level data were not available, preventing examination of patient heterogeneity.
Limited to a small number of included studies (four trials).
Definitions of clinical endpoints, particularly myocardial infarction and MACCE, differed slightly across the included trials.
Data regarding outcomes in relation to the completeness of revascularization were not systematically collected.
Individual-level data were not available
Reduced number of included studies (4 RCTs)
Definition of clinical endpoints differed slightly across trials
Definition of myocardial infarction differed among the four studies

Discussion

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Implication

Similar 5-year survival with PCI or CABG in left main stenosis; reinforces CABG for lower MACCE in complex anatomy.

Cite This Study

D’Ascenzo et al. (2020) conducted a meta-analysis in Unprotected left main (ULM) stenosis (n=4,394). Coronary artery bypass graft (CABG) vs. Percutaneous coronary intervention (PCI) was evaluated on All-cause death (OR 0.93, 95% CI 0.71-1.21, p=0.58). Coronary artery bypass grafting showed no significant difference in 5-year all-cause mortality compared to percutaneous coronary intervention in patients with unprotected left main stenosis (OR 0.93).

synapsesocial.com/papers/6a8465ba002ab1506fb2b2ef https://doi.org/10.1093/ehjqcco/qcaa041

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Percutaneous vs. surgical revascularization for patients with unprotected left main stenosis: a meta-analysis of 5-year follow-up randomized controlled trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Percutaneous vs. surgical revascularization for patients with unprotected left main stenosis: a meta-analysis of 5-year follow-up randomized controlled trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider