Outcomes of Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery at >10-year Follow-up in Patients with Unprotected Left Main Coronary Artery Disease: An Analysis of 3,904 Patients

Khan, Mahin

Outcomes of Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery at >10-year Follow-up in Patients with Unprotected Left Main Coronary Artery Disease: An Analysis of 3,904 Patients

Wednesday, May 22, 2019

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

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

Malalai Manan, M.B, B.S , King Edward Medical University, Lahore, Pakistan

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

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

Salim S Virani, MD , 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

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

Background
There is a paucity of data comparing long-term outcomes of unprotected left main coronary artery (ULMCA) revascularization with Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting.

Methods
We performed aggregate data meta-analyses of clinical outcomes [all-cause mortality, stroke, non-fatal myocardial infarction (MI), repeat revascularization and a composite of death, MI and stroke (MACCE)] in studies reporting a minimum of 7-year outcomes of PCI versus CABG for ULMCA disease. An extensive literature search (to December 31, 2018) identified 5 studies (all observational). Effect size for individual clinical outcomes were estimated with odds ratio (OR) and 95% confidence intervals (CI) using a random-effects model.

Results
A total of 3,904 patients were included in this analysis. Baseline demographic and clinical characteristics were comparable between the two groups. A weighted mean follow-up of 10.2 years was available. At the longest available follow-up, patients in the PCI and CABG groups were comparable in terms of all-cause mortality (OR 0.78, CI 0.59- 1.03) and MACCE (OR 0.90, CI 0.74- 1.10). However, patients in the PCI group had a significant advantage in terms of reduced risk of stroke (OR 0.38, CI 0.25- 0.59) but higher rates of repeat revascularization (OR 2.60, CI 1.35- 5.03) and non-fatal MI (OR 1.50, CI 1.04- 2.16) (table 1).

Conclusions
At a weighted mean follow up of 10.2 years, PCI is comparable to CABG in terms of MACCE and all-cause mortality. PCI was however associated with significantly lower risk of stroke and higher risk of repeat revascularization and non-fatal MI.