Percutaneous coronary intervention versus coronary artery bypass graft for left main coronary artery disease: A meta-analysis

Gallo, Michele; Blitzer, David; Laforgia, Pietro L; Doulamis, Ilias P.; Perrin, Nils; Bortolussi, Giacomo; Guariento, Alvise; Putzu, Alessandro

doi:10.1016/j.jtcvs.2020.04.010

Cited by 42 publications

(30 citation statements)

References 45 publications

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“…Similar to the recently published meta-analysis of five randomized trials conducted by Gallo et al in patients with left main disease not stratified for CKD, 31 our study found that CABG reduced the risk of long-term MI and repeat revascularization compared with PCI in CKD patients with multivessel and/or left main disease. Moreover, CABG was also associated with lower long-term all-cause mortality than PCI in the current meta-analysis.…”

Section: Discussionsupporting

confidence: 91%

Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis

Cui

Hong

Yuan

et al. 2021

Therapeutic Advances in Chronic Disease

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Background: The relative role of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stent implantation in patients with chronic kidney disease (CKD) and complex coronary artery disease (CAD) remains debatable due to the lack of randomized controlled trials (RCTs). We therefore performed this meta-analysis to compare the outcomes of the two strategies in CKD patients with multivessel and/or left main disease. Methods: Electronic databases including PubMed, EMBASE and Cochrane Library were comprehensively searched to identify the eligible subgroup analysis of RCTs and propensity-matched registries. The primary endpoint was all-cause mortality during the longest follow-up. Results: Five subgroup analyses of RCTs and six propensity-matched registries involving 26,441 patients were analyzed. Overall, the strategy of CABG was associated with lower risks of long-term mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.74–0.93], myocardial infarction (OR, 0.41; 95% CI, 0.27–0.62), and repeat revascularization (OR, 0.25; 95% CI, 0.16–0.39) compared with PCI in CKD patients with complex CAD. However, CABG was slightly associated with higher risk of stroke than PCI (OR, 1.33; 95% CI, 1.00–1.77). Nonetheless, the higher stroke risk in the CABG group no longer existed during long-term follow-up (OR, 0.92; 95% CI, 0.37–2.25) (>3 years). Conclusion: This meta-analysis supports the current guideline advising CABG for patients with CKD and complex CAD. At the expense of slightly increased risk of stroke, CABG reduces the incidences of long-term all-cause death, myocardial infarction and repeat revascularization compared with PCI.

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Section: Discussionsupporting

confidence: 91%

Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis

Cui

Hong

Yuan

et al. 2021

Therapeutic Advances in Chronic Disease

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“…In the pre‐DES era, previous meta‐analyses did not found significant differences in long‐term survival between PCI and CABG in diabetic patients, and that was also recently observed in both cardiac and non‐cardiac mortality where better survival with CABG was seen only in the DES era 13,33‐36 . Still, multiple previous meta‐analyses suggested better outcomes of CABG than PCI 7,16‐18,31,32 . Spadaccio et al 7 showed that CABG had better outcomes than DES PCI regarding MI, stroke, and repeat revascularization.…”

Section: Discussionmentioning

confidence: 95%

“…Previous meta‐analyses showed that CABG has lower all‐cause mortality than PCI for the management of CHD, 7,16‐18,31,32 but the long‐term outcomes were not analyzed thoroughly in patients with T2DM. Therefore, this meta‐analysis of RCTs to explore the long‐term effectiveness between CABG and PCI in patients T2DM and to study the temporal trends using a cumulative meta‐analysis.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary heart disease and type 2 diabetes mellitus: Cumulative meta‐analysis

Xie

Huang²,

Zhu

et al. 2021

Clinical Cardiology

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Previous meta‐analyses showed that coronary artery bypass grafting (CABG) has lower all‐cause mortality than percutaneous coronary intervention (PCI) for the management of coronary heart disease (CHD), but the long‐term outcomes were not analyzed thoroughly in patients with type 2 diabetes mellitus (T2DM). To perform a meta‐analysis of randomized controlled trials (RCTs) to explore the long‐term effectiveness between CABG and PCI in patients with T2DM and study the temporal trends using a cumulative meta‐analysis. PubMed, Embase, Cochrane library, and Clinical Trials Registry for eligible RCTs published up to September 2020. The outcomes were all‐cause death, cardiac death, myocardial infarction, repeat revascularization, and stroke. Nine RCTs and 4566 patients were included. CABG resulted in better outcomes than PCI in terms of all‐cause death (RR = 1.41, 95%CI: 1.22–1.63, p < 0.001), cardiac death (RR = 1.56, 95%CI: 1.25–1.95, p < 0.001), and repeat revascularization (RR = 2.68, 95%CI: 1.86–3.85, p < 0.001), but with difference regarding the occurrence of myocardial infarction (RR = 1.20, 95%CI: 0.78–1.85, p = 0.414), while PCI was associated with better outcomes in terms of stroke occurrence (RR = 0.51, 95%CI: 0.34–0.77, p = 0.001). The cumulative meta‐analysis for all‐cause death showed that the differences between CABG and PCI started to be significant at 3 years of follow‐up, while the difference became significant at 5 years for cardiac death. In patients with CHD and T2DM, CABG results in better outcomes than PCI in terms of all‐cause death, cardiac mortality, and repeat revascularization, while PCI had better outcomes in terms of stroke. The differences are mainly observed over the long‐term follow‐up.

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“… 45 A second meta-analysis including 4595 patients with LMCAD from five RCT showed no differences in all-cause mortality or MI between CABG and PCI with higher rates of revascularization in the PCI group at 5 years’ follow-up. 46 Finally, the most recent meta-analysis comparing the two types of revascularization included 4612 patients from five trials. 47 No differences were found between PCI and CABG regarding all-cause mortality or cardiac death.…”

Section: Lesion Subsetsmentioning

confidence: 99%

The year in cardiovascular medicine 2020: interventional cardiology

Alfonso

Gonzalo

Rivero

et al. 2021

European Heart Journal

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Percutaneous coronary intervention versus coronary artery bypass graft for left main coronary artery disease: A meta-analysis

Cited by 42 publications

References 45 publications

Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis

Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary heart disease and type 2 diabetes mellitus: Cumulative meta‐analysis

The year in cardiovascular medicine 2020: interventional cardiology

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