CABG Surgery Remains the best Option for Patients with Left Main Coronary Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled Trials

Soares, Artur Freire; Miranda, Rodrigo; Araújo, Mayara Lopes; Menezes, Alexandre; Silva, Frederico Pires Vasconcelos; Lima, Ricardo Carvalho

doi:10.21470/1678-9741-2017-0081

Cited by 2 publications

(1 citation statement)

References 17 publications

(27 reference statements)

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“… 16 17 Sá et al recently published another meta-analysis suggesting similar results but with no significant difference in MACCE at 1-year follow-up. 18 The authors mentioned that no definitive conclusion can be made from the evidence due to heterogeneity in study outcomes, procedural strategies and complexity of coronary lesions. 18 Unlike the previous meta-analyses, 16 17 the more recent one 18 found no significant difference in MACCE which may represent improvement of outcomes associated with the evolution of interventional techniques.…”

Section: Discussionmentioning

confidence: 99%

Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre

et al. 2018

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PurposeIn this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre.MethodsThis prospective study enrolled all patients with unprotected left main stem disease undergoing revascularisation from January 2013 to June 2014. Baseline characteristics, hospital presentation and hospital stay length were collected. Patients were followed up at 1, 2 and 3 years. Primary outcomes of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) were defined as death, Q wave myocardial infarction, stroke, repeat revascularisation and readmission within 30 days.Results56 patients with significant left main stem coronary artery disease were identified from the clinical registry. 27 patients underwent PCI (median age 67.7) and 29 CABG (median age 68.6). PCI patients had a higher surgical risk as measured by mean euroSCORE (4.95±5.8 vs 3.11±3.85). At 3 years, total MACCE occurred in 29.6% of the PCI cohort and 27.5% of the CABG cohort. Death occurred in three patients in the PCI group within the first 6 months. Death occurred in one patient in the CABG group over 2 years postprocedure. Two patients in the CABG cohort presented with Transient Ischemic Attacks (TIAs) at 2-year follow-up. At 3 years, revascularisation occurred in three patients in the PCI cohort. There were no revascularisation events in the CABG cohort.ConclusionsPCI with modern drug eluting stents is a reasonable treatment option for unprotected left main stem disease in a non surgical centre.

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Section: Discussionmentioning

confidence: 99%

Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre

et al. 2018

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Cardiac surgery 2017 reviewed

et al. 2018

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For the year 2017, more than 21,000 published references can be found in PubMed when entering the search term "cardiac surgery". This review focusses on conventional cardiac surgery, considering the new interventional techniques only if they were directly compared to classic techniques but also entails aspects of perioperative intensive care management. The publications last year provided a plethora of new and interesting information that helped to quantify classic surgical treatment effects and provided new guidelines for the management of structural heart disease, which made comparisons to interventional techniques easier. The field of coronary bypass surgery was primarily filled with confirmatory evidence for the beneficial role of coronary artery bypass grafting for complex coronary disease and equal outcomes for percutaneous coronary intervention for less complex disease including main stem lesions. For aortic valve treatment, the new guidelines provide an equal recommendation for surgical and transcatheter aortic valve replacement for high and intermediate risk giving specific check lists to individualize decision-making by the heart team. For low-risk aortic stenosis, surgical valve replacement remains the primary indication. For the mitral valve, the importance of surgical experience of the individual surgeon on short- and long-term outcome was presented and the prognostic impact of mitral repair for primary mitral regurgitation was emphasized. In addition, there were many relevant and interesting other contributions from the purely operative arena in the fields of tricuspid disease as well as terminal heart failure (i.e., transplantation and ventricular assist devices). While this article attempts to summarize the most pertinent publications, it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.

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CABG Surgery Remains the best Option for Patients with Left Main Coronary Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled Trials

Cited by 2 publications

References 17 publications

Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre

Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre

Cardiac surgery 2017 reviewed

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