Meta-Analysis Evaluates PCI With DES Versus CABG in Unprotected Left Main CAD

December 5, 2016—Nitesh Nerlaker, MD, et al assessed whether percutaneous coronary intervention (PCI) using drug-eluting stents is as safe and effective as coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery disease. The findings are available online ahead of print in Circulation: Cardiovascular Interventions.

The background of the study is that current guidelines suggest that CABG should be the preferred revascularization method for unprotected left main coronary artery stenosis. 

As summarized in Circulation: Cardiovascular Interventions, digital databases and manual searches were performed for randomized trials comparing PCI and CABG for unprotected left main coronary artery stenosis. Among 3,887 potentially relevant studies, five met the inclusion criteria.

The primary safety endpoint was defined as the composite of all-cause death, myocardial infarction, or stroke. Secondary endpoints included a clinical effectiveness composite, which was defined as all-cause death, myocardial infarction, stroke, or repeat revascularization. Summary estimates were obtained using random-effects modeling. In total, 4,594 patients were included in the analysis.

The investigators found that there was no significant difference in the primary safety endpoint between the revascularization strategies (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.79–1.17; P = .73).

However, when compared with CABG, PCI was less effective (OR, 1.36; 95% CI, 1.18–1.58; P < .001) because of significantly higher rates of repeat revascularization (OR, 1.85; 95% CI, 1.53–2.23; P < .001). The incidence of all-cause death (OR, 1.03; 95% CI, 0.78–1.35; P = .61), myocardial infarction (OR, 1.46; 95% CI, 0.88–2.45; P = .08), and stroke (OR, 0.88; 95% CI, 0.39–1.97; P = .53) did not differ between PCI and CABG.

The study demonstrated that PCI using drug-eluting stents and CABG are equally safe methods of revascularization for patients at low surgical risk with significant unprotected left main coronary artery stenosis; however, CABG is associated with significantly lower rates of repeat revascularization, concluded the investigators in Circulations: Cardiovascular Interventions.