TY - JOUR
T1 - Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials
AU - Testa, Luca
AU - Latib, Azeem
AU - Bollati, Mario
AU - Montone, Rocco Antonio
AU - Colombo, Antonio
AU - Crea, Filippo
AU - Bedogni, Francesco
PY - 2017
Y1 - 2017
N2 - Background The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. Aim The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR). Results We identified 6 Randomised Controlled Trials totalling 4717 patients allocated to PCI or CABG. At 1 year follow up, PCI and CABG were substantially equivalent with respect to the rates of MACE [PCI 8.5% vs CABG 8.9%, OR 1.02,(0.76â1.36), p = 0.9], death [PCI 5.4% vs CABG 6.6%, OR 0.81,(0.63â1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80 (0.59â1.07), p = 0.14]. Notably, PCI was associated with a significantly lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17â0.79), p = 0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%, OR 2.00(1.46â2.75), p<0.01]. At a median follow up of 5years, the rates of MACE were similar between the two strategies: PCI 14.6% vs CABG 13.8%, OR 1.02(0.76â1.38), p = 0.89. Likewise, the rates of death [PCI 8% and CABG 7.7%, OR 1(0.77â1.31), P = 0.9], MI [PCI 6.1% vs CABG 5%, OR 1.41(0.85â2.34), P = 0.19, I259%], and stroke [PCI 2% vs CABG 2.2%, OR 0.85(0.42â1.81), p = 0.65,] were similar while PCI was associated with a significantly higher rate of TVR [14.5% vs CABG 8.9%, OR 1.73(1.41â2.13), p<0.01]. Conclusion In patients with UPLM disease, PCI and CABG are associated with similar rates of MACE and mortality at 1 year as well as after 5 years. Differences can be detected for individual end points at both short and long term FU.
AB - Background The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. Aim The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR). Results We identified 6 Randomised Controlled Trials totalling 4717 patients allocated to PCI or CABG. At 1 year follow up, PCI and CABG were substantially equivalent with respect to the rates of MACE [PCI 8.5% vs CABG 8.9%, OR 1.02,(0.76â1.36), p = 0.9], death [PCI 5.4% vs CABG 6.6%, OR 0.81,(0.63â1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80 (0.59â1.07), p = 0.14]. Notably, PCI was associated with a significantly lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17â0.79), p = 0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%, OR 2.00(1.46â2.75), p<0.01]. At a median follow up of 5years, the rates of MACE were similar between the two strategies: PCI 14.6% vs CABG 13.8%, OR 1.02(0.76â1.38), p = 0.89. Likewise, the rates of death [PCI 8% and CABG 7.7%, OR 1(0.77â1.31), P = 0.9], MI [PCI 6.1% vs CABG 5%, OR 1.41(0.85â2.34), P = 0.19, I259%], and stroke [PCI 2% vs CABG 2.2%, OR 0.85(0.42â1.81), p = 0.65,] were similar while PCI was associated with a significantly higher rate of TVR [14.5% vs CABG 8.9%, OR 1.73(1.41â2.13), p<0.01]. Conclusion In patients with UPLM disease, PCI and CABG are associated with similar rates of MACE and mortality at 1 year as well as after 5 years. Differences can be detected for individual end points at both short and long term FU.
KW - Agricultural and Biological Sciences (all)
KW - Biochemistry, Genetics and Molecular Biology (all)
KW - Coronary Artery Bypass
KW - Humans
KW - Percutaneous Coronary Intervention
KW - Regression Analysis
KW - Agricultural and Biological Sciences (all)
KW - Biochemistry, Genetics and Molecular Biology (all)
KW - Coronary Artery Bypass
KW - Humans
KW - Percutaneous Coronary Intervention
KW - Regression Analysis
UR - http://hdl.handle.net/10807/110466
UR - http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0179060&type=printable
U2 - 10.1371/journal.pone.0179060
DO - 10.1371/journal.pone.0179060
M3 - Article
SN - 1932-6203
VL - 12
SP - e0179060-e0179060
JO - PLoS One
JF - PLoS One
ER -