Meta-Analysis Compares PCI and CABG to Treat Unprotected Left Main Coronary Artery Stenosis

August 24, 2009—In the Journal of the American College of Cardiology: Cardiovascular Interventions, Hursh Naik, MD, et al published findings from a study that sought to understand the total weight of evidence regarding outcomes in coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in unprotected left main coronary artery (ULMCA) stenosis (2009;2:739-747). The background of the study is that after a diagnosis of significant ULMCA stenosis in an individual who is a candidate for surgery, CABG is recommended by the American College of Cardiology/American Heart Association guidelines, whereas PCI is not recommended (class III), the investigators noted.

In the study, databases were searched for clinical studies that reported outcomes after PCI and CABG for the treatment of ULMCA stenosis. Ten studies were identified that included a total of 3,773 patients. Meta-analysis showed that death, myocardial infarction, and stroke (major adverse cardiovascular or cerebrovascular events) were similar in the PCI- and CABG-treated patients at 1 year (odds ratio [OR]: 0.84 [95% confidence interval [CI]: 0.57 to 1.22]), 2 years (OR: 1.25 [95% CI: 0.81 to 1.94]), and 3 years (OR: 1.16 [95% CI: 0.68 to 1.98]). Target vessel revascularization was significantly higher in the PCI group at 1 year (OR: 4.36 [95% CI: 2.6 to 7.32]), 2 years (OR: 4.2 [95% CI: 2.21 to 7.97]), and 3 years (OR: 3.3 [95% CI: 0.96 to 11.33]). There was no difference in mortality in PCI- versus CABG-treated patients at 1 year (OR: 1 [95% CI: 0.7 to 1.41]), 2 years (OR: 1.27 [95% CI: 0.83 to 1.94]), and 3 years (OR: 1.11 [95% CI: 0.66 to 1.86]).

The investigators concluded that this analysis reveals no difference in mortality or major adverse cardiovascular or cerebrovascular events for up to 3 years between PCI and CABG for the treatment of ULMCA stenosis. However, PCI patients had a significantly higher risk of target vessel revascularization. In selected patients with ULMCA stenosis, PCI is emerging as an acceptable option.