Abstract 13250: Percutaneous Coronary Intervention with Drug-Eluting Stents Versus Coronary Artery Bypass Graft Surgery for Unprotected Left Main Coronary Artery Stenosis: A Meta-Analysis of Randomized Clinical Trials
Background: Patients with unprotected left main coronary artery (ULMCA) stenosis are increasingly treated with PCI using DES. However, there is paucity of long-term data from randomized clinical trials comparing PCI with DES vs. CABG for ULMCA stenosis.
Methods: We performed aggregate data meta-analyses of clinical outcomes from randomized studies comparing PCI with DES vs. CABG for ULMCA stenosis & reporting at least 12 months of follow-up. A search of Medline & conference proceedings between 01/2003 and 04/2011 identified 4 studies (1,611 patients; PCI = 809 & CABG = 802). Death, non-fatal myocardial infarction (MI), stroke, repeat revascularization, MACCE (death, MI, repeat revascularization or stroke) and composite safety outcome of death, MI or stroke were extracted at 30-days, 12-months, 24-months & 36-months. Summary odds ratios & 95% confidence intervals were calculated using random-effects model.
Results: No major inter-group differences in baseline socio-demographic, clinical & angiographic characteristics were observed. Compared with their CABG counterparts, patients in the PCI arm had shorter hospital stay (11.5 vs. 4.7 days, P < 0.05), and experienced a lower incidence of stroke at 30-days (OR 0.2, 95% CI 0.04 - 0.8), 12-months (OR 0.2, 95% CI 0.04 - 0.6) and 24-months (OR 0.3, 95% CI 0.1 - 0.8). PCI was associated with a higher incidence of repeat revascularization at 12-months (OR 2.2, 95% CI 1.5 - 3.2), 24-months (OR 2.0, 95% CI 1.4 - 2.8) and 36-months (OR 2.0, 95% CI 1.3 - 2.9). Both groups had comparable death, MI, MACCE and the composite safety outcomes at follow-up (Table I).
Conclusions: In randomized clinical trials, revascularization of ULMCA stenosis with PCI using DES is associated with a shorter hospital stay, reduced rate of stroke but an increased rate of repeat revascularization compared to CABG. Both revascularization strategies had comparable mortality, MI, and MACCE outcomes at intermediate term follow-up. Table I : Meta-Analysis Outcomes
- © 2011 by American Heart Association, Inc.