Abstract 2522: A Meta-analysis Of 2587 Patients Treated With Percutaneous Coronary Intervention Or Coronary Artery Bypass Grafting For Unprotected Left Main Coronary Artery Stenosis.
Objective: The treatment of unprotected left main (UPLM) stenosis has traditionally been coronary artery bypass grafting (CABG). Recently, this treatment had been re-examined with the development of percutaneous coronary intervention (PCI). Centers (including ours) have presented results comparing their matched cohorts of CABG and PCI patients for the treatment of UPLM disease. We sought to synthesize these data.
Methods: Biomed Central, Clinicaltrials.gov, Google Scholar, and Pub Med were searched. We included data that met the following criteria 1) Comparison of matched cohorts of CABG and PCI for the treatment of UPLM 2) A minimum of 1 year follow-up 3)Documentation of survival and major adverse cardiac and cardiovascular events (MACCE) 4) > 30 patients in each cohort 5) publication in a referenced journal. 7 studies were found and the DerSimonian-Laird method was used to combine data.
Results: Studies contained a combined 2587 patients. 1723 patients had 1 year or more follow-up. 307 PCI patients underwent BMS implantation and 610 underwent DES implantation. Results showed no survival differences between PCI (pooled 95% 1 year survival, 95% CI (93.5%, 96.4%)) and CABG (94% 1 year survival, 95% CI (92.7%, 95.3%)) (OR = .95, 95% CI (.63, 1.42)), nor across studies (chi-square = 3.99, df=6, p=.6) at 1, 2, and 3 years (Figure1⇓.) MACCE survival at one year was not significantly different (OR = 1.10, 95% CI (0.53, 2.28)), nor at year 2 or 3 (Figure 2⇓).
Conclusions: In matched cohorts amongst multiple centers, PCI and CABG appear to have similar survival and MACCE up to 3 years. Ongoing trials will confirm whether these results are reproducible in randomized populations.