Abstract 17611: Stroke Outcomes : Perucutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting
Background: Stroke is a devastating complication of both PCI and CABG and its likelihood may be a factor in determining the procedure of choice for an individual patient. Stroke risks have however not been compared apart from in single trials and have not been characterized temporally. Studies have suggested that an early excess risk in CABG may be compensated for by a slow but progressive ‘catch-up’ phenomenon in patients undergoing PCI. To test this hypothesis and characterize the temporal stroke risk, we undertook a systematic review to compare patients undergoing CABG or PCI for unprotected left main or MVD revascularization.
Methods: Studies published between January of 1994 and 2012 of PCI vs. CABG for UPLM stenosis and or MVD were identified using an electronic search and established meta-analytical guidelines. Studies reporting stroke outcomes were then included in the analysis. The results were reviewed using the random effects model of DerSimonian and Laird. The endpoint evaluated was stroke at progressive time points - 1,2,3,4,5 and greater than 5 years . Univariate meta regression was performed on apriori selected variables. Heterogeneity was assessed by Q-statistic and sensitivity analysis was performed.
Results: From 22714 initial citations, 65 studies were included (55,694 total patients, PCI 30,029 and CABG 25,665) of which eight were randomized comparisons. A risk ratio (RR) of 0.48 (0.35-0.67) was found at 1 year of follow up for PCI with stenting vs. CABG, 0.80 (0.59-1.08) at 2 years, 0.73(0.59-0.91) at 3 years, 0.68(0.56-0.82) at 4 years , 0.70(0.46-1.06) at 5 years and 0.72(0.49-1.07) at greater than 5 years of follow up. Meta regression analysis showed that TVR weakly predicted stroke rates .
Conclusion: We conclude that there is a significantly lower risk of stroke with PCI as compared to CABG upto year 5. There is also a trend towards a significant reduction beyond 5 years , which suggests that there is no late catch up phenomenon.
- © 2012 by American Heart Association, Inc.