Abstract 19671: Percutaneous Coronary Interventions with Drug-Eluting Stents for Unprotected Left Main Coronary Artery Stenosis are Associated with Reduced Stroke and Increased Repeat Revascularization Risk Compared with Coronary Artery Bypass Graft Surgery: Results from a Contemporary Aggregate Data Meta-Analysis
Background: Patients with unprotected left main coronary artery (ULMCA) stenosis are increasingly treated with PCI using DES. Its benefits compared to CABG remain controversial. We hypothesized that PCI with DESs for ULMCA stenosis is safe and effective compared with CABG.
Methods: We performed meta-analyses of clinical outcomes (death; MI; stroke; repeat revascularization; and their composites) in studies comparing PCI with DES vs. CABG in patients with ULMCA stenosis. A search of Medline and conference proceedings(01/2000–03/2010) identified 18 studies enrolling 5483 patients (2126 underwent PCI&3357 underwent CABG). Summary O.R. calculated using random-effects model.
Results: Overall, no major inter-group differences in baseline demographic variables&co-morbidities were observed. The PCI-DES group had shorter hospitalization (5.6 ± 3.9 vs.13.3 ± 6.2 days, P=0.01)&similar mean follow-up as CABG (16.3 ± 6.9 vs. 19.5 ± 9.6 mo, P=0.3). At 30 days, patients in the PCI-DES group had lower risk of stroke (OR= 0.27, 95% C.I. 0.10–0.77), MACE (composite of death, MI, and repeat revascularization; OR= 0.46; 95% CI, 0.27–0.79), and MACCE (composite of death, MI, stroke, and repeat revascularization; OR= 0.49; 95% CI, 0.26–0.93), but comparable death and MI risks to their CABG counterparts. At 12 months, PCI-DES patients had lower stroke risk (OR= 0.32; 95% CI, 0.15–0.68), higher repeat revascularization risk (OR= 6.47; 95% CI, 3.86–10.84), and comparable risks of death, MI, MACE, and MACCE to CABG patients. Similar trends were observed at the last reported follow-up (Table).
Conclusions: In patients with ULMCA stenosis, PCI with DES shows a better short- and intermediate-term safety with lower stroke and similar mortality and MI risk compared to CABG, but is associated with higher intermediate-term risk of repeat revascularization. Longer follow-up data are needed for more conclusive evidence on the comparative effectiveness of both strategies. heterogeneity
- © 2010 by American Heart Association, Inc.