Clinical Outcomes of Percutaneous Coronary Intervention for Unprotected Left Main Bifurcation Disease versus Coronary Artery Bypass Grafting at Intermediate Follow-up: A Meta-Analysis of 3,470 Patients.

Alam, Mahboob

Clinical Outcomes of Percutaneous Coronary Intervention for Unprotected Left Main Bifurcation Disease versus Coronary Artery Bypass Grafting at Intermediate Follow-up: A Meta-Analysis of 3,470 Patients.

Wednesday, May 22, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Mahboob Alam, M.D., FSCAI , Baylor College of Medicine, Sugarland, TX

Mahin R Khan, MD , McLaren Flint - Michigan State University, Flint, MI

Waqas Ahmad, M.B, B.S. , Nishtar Medical College, Multan, Pakistan

Salim S Virani, MD , Baylor College of Medicine, Houston, TX

Ihab Hamzeh, MD, FACC , Baylor College of Medicine, Houston, TX

Yochai Birnbaum, MD, FACC, FAHA , Baylor College of Medicine, Houston, TX

Nasser M Lakkis, M.D., FACC, FSCAI , Baylor College of Medicine, Houston, TX

Background:

There is a need for additional evidence comparing Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) for unprotected left main bifurcation disease (LMBD) as PCI for LMBD is procedurally complex and requires technical expertise.

Methods:

A comprehensive literature search to January 2019 identified 4 studies (2 Randomized, 2 Observational) with 3470 patients. Aggregate data meta-analyses of clinical outcomes [all-cause mortality, non-fatal myocardial infarction (MI), repeat revascularization and a composite outcome of major adverse cardiac and cerebrovascular events (MACCE)] comparing PCI and CABG for LMBD were performed. Odds Ratios (OR) and 95% confidence intervals (CI) were estimated using random-effects model.

Results:

We included a total of 3,470 patients in this analysis. Baseline characteristics were comparable between the two groups. At an average follow-up of 4.3 years, PCI and CABG groups experienced comparable all-cause mortality(OR 0.84, CI 0.51- 1.39), stroke(OR 0.27, CI 0.06- 1.24, Absolute Risk Reduction 5.6%), MI(OR 0.77, CI 0.45- 1.33) and MACCE(OR 1.18, 0.93- 1.51) events. Repeat revascularization rates were higher in the PCI group(OR 2.72, CI 1.59- 4.65) compared to CABG(Table 1).

Conclusions:

At an intermediate term follow-up, PCI for unprotected LMBD is a safe alternative compared to CABG with no increased risk of all-cause mortality, MI or MACCE. The disparity between ARR and OR of stroke between the two groups might be secondary to sample size and event rate. However, consistent with published data, PCI is associated with higher rates of repeat revascularization