Long‐term clinical outcomes of coronary artery bypass graft surgery compared to those of percutaneous coronary intervention with second generation drug eluting stents in patients with stable angina and an isolated lesion in the proximal left anterior descending artery

Matsoukis, Ioannis; Καρανάσος, Αντώνιος; Patsa, Chrysoula; Triantafyllou, Konstantinos; Καντζάνου, Μαρία; Drakopoulou, Maria; Tsiamis, Eleftherios; Latsios, George; Synetos, Αndreas; Petridou, Eleni; Tousoulis, Dimitris; Toutouzas, Konstantinos

doi:10.1002/ccd.29247

Cited by 3 publications

(3 citation statements)

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“…Third, we could not conduct subgroup analyses based on number diseased vessels, locations of diseased vessels including left main, proximal left anterior descending artery, or patient's comorbidity such as diabetes mellitus, all of which could affect the outcomes of multivessel coronary artery disease. [42][43][44] Forth, the follow-up periods of studies including only PCI with DES were shorter than those of other studies, which could lead to non-significantly different outcomes of the PCI with DES group compared to CABG group. Furthermore, there could be heterogeneity regarding surgical techniques used in CABG or devices used in PCI, which could affect the outcomes.…”

Section: Discussionmentioning

confidence: 98%

“…However, definitions of these commonly used clinical variables were frequently not provided in most studies. Third, we could not conduct subgroup analyses based on number diseased vessels, locations of diseased vessels including left main, proximal left anterior descending artery, or patient's comorbidity such as diabetes mellitus, all of which could affect the outcomes of multivessel coronary artery disease [42][43][44]. Forth, the follow-up periods of studies including only PCI with DES were shorter than those of other studies, which could lead to non-significantly different outcomes of the PCI with DES group compared to CABG group.…”

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confidence: 99%

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Network meta‐analysis of treatment strategies in patients with coronary artery disease and low left ventricular ejection fraction

Yokoyama

Fukuhara

Mori

et al. 2021

Journal of Cardiac Surgery

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Objective: The optimal treatment strategy in patients with coronary artery disease (CAD) and low left ventricular ejection fraction (LVEF) remains controversial. Herein, we conducted a network meta-analysis comparing coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), and optimal medical therapy (OMT) in patients with CAD and low LVEF.Methods: MEDLINE and EMBASE were searched through March, 2021 to identify randomized controlled trials (RCTs) and propensity-score matched (PSM) studies comparing CABG, PCI, and OMT. We extracted hazard ratios (HRs) of the outcomes.Results: A total of three RCTs and 10 PSM trials were identified, yielding a total of 18,855 patients with CAD with low EF who were treated with CABG (n = 9241), PCI (n = 8771), or OMT (n = 1003). All-cause mortality was significantly lower in patients with CABG compared with those with PCI or OMT (HR [95% confidence interval (CI)] = 0.72 [0.62-0.82], p < .001, HR [95% CI] = 0.65 [0.51-0.82], p = .004, respectively), while no difference was observed between PCI and OMT. The rates of MI were significantly lower in patients treated with CABG compared to those treated with PCI or OMT. However, the subgroup analysis by limiting the PCI group to patients who received drug-eluting stent (DES) showed similar all-cause mortality between CABG and PCI, while both CABG and PCI were associated with lower allcause mortality compared with OMT. Concluion:The present study demonstrated that CABG was the appropriate treatment strategy in patients with CAD and low LVEF. Further long-term trials were warranted to investigate outcomes of PCI with DES compared with CABG.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Network meta‐analysis of treatment strategies in patients with coronary artery disease and low left ventricular ejection fraction

Yokoyama

Fukuhara

Mori

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4] Consequently, revascularisation of these patients with concomitant one-vessel or two-vessel CAD has a class I recommendation for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in the current European Society of Cardiology (ESC) guidelines. 5 Recent studies suggest a similar risk of mortality with PCI or CABG in patients with isolated P-LAD lesions [6][7][8] ; however, there is an absence of data regarding the optimal mode of revascularisation to improve very long-term prognosis in patients with a P-LAD lesion and multivessel disease (MVD). 9 10 Cavalcante et al 10 reported a numerically lower rate…”

Section: Introductionmentioning

confidence: 99%

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Ono

Hara

Gao

et al. 2022

Heart

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ObjectiveWe sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).MethodsThis post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.ResultsAmong 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.ConclusionsAmong patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.Trial registration numberSYNTAXES:NCT03417050; SYNTAX:NCT00114972.

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The Current State of Coronary Revascularization: Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery

et al. 2021

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The question of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery remains among the most important questions in the treatment of coronary artery disease. The leading North American and European societies largely agree on the current guidelines for the revascularization of unprotected left-main disease (ULMD) and multivessel disease (MVD) which are largely supported by the outcomes of several large randomized trials including SYNTAX, PRECOMBAT, NOBLE, and EXCEL. While these trials are of the highest quality, currently available, they suffer several limitations, including the use of bare metal and/or first-generation drug-eluting stents in early trials and lack of updated surgical outcomes data. The objective of this review is to briefly discuss these key early trials, as well as explore contemporary studies, to provide insight on the current state of coronary revascularization. Evidence suggests that in ULMD and MVD, there are similar mortality rates for CABG and PCI but PCI is associated with fewer “early” strokes, whereas CABG is associated with fewer “late” strokes, myocardial infarctions, and lower need for repeat revascularization. Additionally, studies suggest that CABG remains superior to PCI in patients with intermediate/high SYNTAX scores and in MVD with concomitant proximal left anterior descending (pLAD) artery stenosis. Despite the preceding research and its basis for our current guidelines, there remains significant variation in care that has yet to be quantified. Emerging studies evaluating second-generation drug-eluting stents, specific lesion anatomy, and minimally invasive and hybrid approaches to CABG may lend itself to more individualized patient care.

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Long‐term clinical outcomes of coronary artery bypass graft surgery compared to those of percutaneous coronary intervention with second generation drug eluting stents in patients with stable angina and an isolated lesion in the proximal left anterior descending artery

Cited by 3 publications

References 28 publications

Network meta‐analysis of treatment strategies in patients with coronary artery disease and low left ventricular ejection fraction

Network meta‐analysis of treatment strategies in patients with coronary artery disease and low left ventricular ejection fraction

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

The Current State of Coronary Revascularization: Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery

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