Comparison by Meta-Analysis of 10-year Outcomes of Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in Patients with Unprotected Left Main Coronary Artery Disease
Presenter
Mahboob Alam, M.D., FSCAI, Baylor College of Medicine, Houston, TX
Mahin R Khan, MD1, Ihab R Hamzeh, MD, FACC2, Yochai Birnbaum, MD, FACC, FAHA2 and Mahboob Alam, M.D., FSCAI2, (1)McLaren Flint, Flint, MI, (2)Baylor College of Medicine, Houston, TX
Keywords: Coronary, Drug-eluting Stent (DES) and Left Main and Bifurcations
Background:
Data comparing very long-term outcomes of unprotected left main coronary artery (ULMCA) revascularization with Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) is scarce and is continuing to evolve.
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 10-year follow-up. An extensive literature search (to January 20, 2021) identified 5 studies (2 randomized, 3 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 4,000 patients were included in this analysis. Baseline demographic and clinical characteristics were comparable between the two groups. At the longest available follow-up, patients in the PCI and CABG groups were comparable in terms of all-cause mortality (OR 0.95, CI 0.81- 1.12), MACCE (OR 0.98, CI 0.83- 1.16), stroke (OR 0.73, CI 0.36- 1.49), non-fatal MI (OR 1.19, CI 0.72- 1.97) but higher rates of repeat revascularization (OR 2.48, CI 1.15- 5.35) (Table 1).
Conclusions:
At a very long-term follow-up, PCI and CABG have a comparable mortality, risk of stroke, non-fatal MI and MACCE. PCI, however, is associated with an increased risk of repeat revascularization.
Table 1. Meta-analyses outcomes. | Outcomes | Studies | Patients | Event Rate | OR (Random) 95% CI |
| PCI | CABG |
| All-cause mortality | 5 | 4000 | 411/1911 (21.5) | 464/2089 (22.2) | 0.95 (0.81, 1.12) |
| Stroke | 3 | 1055 | 12/452 (2.7) | 27/603 (4.5) | 0.73 (0.36, 1.49) |
| Repeat Revascularization | 4 | 3295 | 549/1554 (35.3) | 359/1741 (20.1) | 2.48 (1.15, 5.35) |
| Myocardial Infarction | 3 | 1055 | 29/452 (6.4) | 43/603 (7.1) | 1.19 (0.72, 1.97) |
| MACCE† | 3 | 3190 | 352/1502 (23.4) | 410/1688 (24.3) | 0.98 (0.83, 1.16) |
Data are presented as n (%), unless otherwise noted. † Composite endpoint of death, nonfatal MI and stroke.