March 2, 2020
Meta-Analysis Compares DES and CABG for Left Main Coronary Artery Disease
March 2, 2020—Findings from a meta-analysis comparing percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) versus coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) were published by Yousif Ahmad, MD, et al online ahead of print in European Heart Journal (EHJ).
After searching the Medline, Cochrane Central, and Embase databases from December 2000 through December 2019 for all randomized controlled trials of LMCAD revascularization, the investigators identified five eligible trials including 4,612 patients. The primary efficacy endpoint was all-cause mortality, and secondary endpoints included cardiac death, myocardial infarction (MI), stroke, and unplanned revascularization.
At a mean follow-up of 5.6 years, the investigators noted no significant difference for the risk of all-cause mortality after PCI with DESs versus CABG (relative risk [RR], 1.03; 95% confidence interval [CI], 0.81–1.32; P = .779).
There were also no significant differences in the risk of cardiac death, MI, or stroke between the PCI and CABG groups. However, procedural MI was more common after CABG, and nonprocedural MI was more common after PCI. The results are summarized as:
- Cardiac death: RR, 1.03; 95% CI, 0.79–1.34; P = .817
- MI: RR, 1.22; 95% CI, 0.96–1.56; P = .110; I2 = 0.0%
- Stroke: RR, 0.74; 95% CI, 0.35–1.50; P = .400
The investigators did identify a difference in unplanned revascularization. At latest follow-up, PCI with DESs had a higher rate of unplanned revascularization than CABG (RR, 1.73; 95% CI, 1.49–2.02; P < .001; I2 = 0.0%), a difference that was present by 12 months but not at 30 days. According to the investigators in EHJ, this difference in long-term revascularization should be considered in heart team discussions.