Why the study?
Does percutaneous coronary intervention with drug-eluting stent reduce the composite of death, MI, or stroke compared to coronary artery bypass grafting in patients with unprotected left main coronary artery disease?
Does percutaneous coronary intervention with drug-eluting stent reduce the composite of death, MI, or stroke compared to coronary artery bypass grafting in patients with unprotected left main coronary artery disease?
PCI with DES is a safe alternative to CABG for unprotected left main coronary artery disease at long-term follow-up, especially for lesions with SYNTAX score ≤ 32, though it carries a higher risk of repeat revascularization.
Supports DES as safe alternative to CABG in left main disease; extends long-term evidence from prior trials.
BACKGROUND: It is still controversial whether percutaneous coronary intervention with drug-eluting stent (DES) is safe and effective compared to coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (ULMCA) disease at long-term follow up (≥ 3 years). METHODS: Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library up to December 6, 2016. The primary endpoint was a composite of death, myocardial infarction (MI) or stroke during the longest follow-up. Death, cardiac death, MI, stroke and repeat revascularization were the secondary outcomes. RESULTS: Four randomized controlled trials and twelve adjusted observational studies involving 14,130 patients were included. DES was comparable to CABG regarding the occurrence of the primary endpoint (HR = 0.94, 95% CI: 0.86-1.03). Besides, DES was significantly associated with higher incidence of MI (HR = 1.56, 95% CI: 1.09-2.22) and repeat revascularization (HR = 3.09, 95% CI: 2.33-4.10) compared with CABG, while no difference was found between the two strategies regard as the rate of death, cardiac death and stroke. Furthermore, DES can reduce the risk of the composite endpoint of death, MI or stroke (HR = 0.80, 95% CI: 0.67-0.95) for ULMCA lesions with SYNTAX score ≤ 32. CONCLUSIONS: Although with higher risk of repeat revascularization, PCI with DES appears to be as safe as CABG for ULMCA disease at long-term follow up. In addition, treatment with DES could be an alternative interventional strategy to CABG for ULMCA lesions with low to intermediate anatomic complexity.
No takes yet. Share an insight, caveat, or question.
Cui et al. (2018) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: