Abstract 18026: Comparative Effectiveness of Pci Versus Cabg for Unprotected Left Main Stenosis- Meta Analysis of Randomzed Controlled Trials
Background The established mode of revascularization for unprotected left main disease is coronary artery bypass grafting (CABG). Percutaneous coronary intervention (PCI) has been increasingly utilized as a viable alternate.
Objectives We sought to evaluate the comparative effectiveness of PCI vs. CABG for left main disease by collating the evidence from four published randomized controlled trials. Data Sources PubMed, Cochrane Register of Controlled Trials, conference proceedings, and internet-based resources of clinical trials. Study Selection Randomized trials comparing PCI vs. CABG for unprotected left main disease evaluating the outcomes of interest [death, myocardial infarction (MI), stroke, revascularization and their composite (MACE) were included.
Results Four randomized trials including 1611 participants (809 in PCI arm and 802 in CABG arm) formed the data set. There was no significant difference in the two groups with regards to baseline characteristics. The weighted mean age was 64 years with 70% men and 32% diabetics. The mean SYNTAX score was 26 in both groups. During a mean follow up of 15 months, the incidence of death was 3% in the PCI arm and 4.2% in the CABG arm [RR 0.75 (0.45, 1.25); p=0.27] .Similarly, there was no difference in the incidence of MI [RR 1(0.57, 1.75); p=0.99] or MACE [RR 1.1 (0.8, 1.5); p=0.26]. PCI was associated with a significant reduction in the risk of stroke [0.2% vs. 1.7%; RR 0.22(0.06, 0.76);p=0.02] but a higher risk of revascularization.[RR 2.09(1.49,2.92);p<0.001].There was no heterogeneity found amongst the trials for these endpoints (I2=0%).
Conclusion This meta analysis of randomized studies demonstrates the safety and efficacy of PCI compared to CABG for left main disease. While there was no difference in mortality, MI or MACE, PCI confered an advantage of significant reduction in the risk of stroke which was balanced by a higher rate of downstream revascularization. PCI could hence be considered a viable option in selected patients.
- © 2011 by American Heart Association, Inc.