Study Compares PCI to CABG in Left Main Coronary Artery Disease

September 20, 2011—In the Journal of the American College of Cardiology, Davide Capodanno, MD, et al published findings from a study that sought to determine the safety and efficacy of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with left main coronary artery (LMCA) disease (2011;58:1426–1432).

According to the investigators, the background of the study is that previous meta-analyses of PCI versus CABG in LMCA disease mainly included nonprospective, observational studies but that several new randomized trials have recently been reported.

As detailed in the Journal of the American College of Cardiology, the investigators identified 1,611 patients from four randomized clinical trials for the present meta-analysis. The primary endpoint was the 1-year incidence of major adverse cardiac and cerebrovascular events (MACCE) defined as death, myocardial infarction (MI), target vessel revascularization (TVR), or stroke.

The investigators reported that PCI was associated with a nonsignificantly higher 1-year rate of MACCE compared with CABG (14.5% vs 11.8%; odds ratio [OR], 1.28; 95% confidence interval [CI], 0.95–1.72; P = .11), which was driven by increased TVR (11.4% vs 5.4%; OR, 2.25; 95% CI, 1.54 –3.29; P < .001). Conversely, stroke occurred less frequently with PCI (0.1% vs 1.7%; OR, 0.15; 95% CI, 0.03–0.67; P = .013). There were no significant differences in rates of death (3% vs 4.1%; OR, 0.74; 95% CI, 0.43–1.29; P = .29) or MI (2.8% vs 2.9%; OR, 0.98; 95% CI, 0.54–1.78; P = .95).

The investigators concluded that in patients with LMCA disease, PCI was associated with nonsignificantly different 1-year rates of MACCE, death, and MI; a lower risk of stroke; and a higher risk of TVR compared with CABG.