Five-year outcomes following PCI with DES versus CABG for unprotected LM coronary lesions: meta-analysis and meta-regression of 2914 patients

Sá, Michel Pompeu Barros de Oliveira; Ferraz, Paulo Ernando; Escobar, Rodrigo; Nunes, Eliobas Oliveira; Soares, Alexandre Magno Macário Nunes; Sá, Frederico Browne Correia de Araújo e; Vasconcelos, Frederico Pires; Lima, Ricardo Carvalho

doi:10.5935/1678-9741.20130013

Cited by 14 publications

(6 citation statements)

References 19 publications

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“…A couple of meta-analyses by Sá et al suggested CABG was the best treatment for ULMCA disease with higher risk of target vessel revascularisation as well as MACCE in the PCI group. 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.…”

Section: Discussionmentioning

confidence: 72%

“… 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: 79%

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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: 72%

Section: Discussionmentioning

confidence: 79%

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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“…Randomized and nonrandomized trials in the DES era showed conflicting results with different follow-up durations. Small meta-analysis studies [ 6 , 7 ] that mainly recruited randomized trials were conducted in the past; however, the outcomes have been variable. We therefore conducted this large, updated meta-analysis study involving randomized and up-to-date published data to review the clinical outcomes between the 2 treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis study comparing percutaneous coronary intervention/drug eluting stent versus coronary artery bypass surgery of unprotected left main coronary artery disease

Vaidya

et al. 2018

Medicine

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“…Coronary artery bypass graft surgery (CABG) still remains the standard care for patients with multivessel coronary artery disease comparing to percutaneous coronary intervention (PCI). This maybe due to its lower rates of major adverse cardiac and cerebrovascular events in short-term and long-term periods [ 1 - 5 ] .…”

Section: Introductionmentioning

confidence: 99%

Association of angiotensin converting enzyme genotype insertion/deletion polymorphism and saphenous vein graft atherosclerosis in Iranian patients

Zeinali

Hashemi

Mirmohammadsadeghi

et al. 2015

Revista Brasileira De Cirurgia Cardiovascular

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OBJECTIVE The aim of this study was to evaluate possible interactions among Angiotensin-I converting enzyme genotype, insertion/deletion polymorphism and atherosclerosis of vein grafts in Iranian patients, and characterize their clinical and demographic profile.METHODS In this cross-sectional study, patients who underwent coronary artery bypass graft surgery more than five years ago, were included for angiographic analysis. Atherosclerosis was determined by quantitative angiography and adjusted Gensini score. The gene angiotensin converting enzyme I/D polymorphism was detected by polymerase chain reaction.RESULTS A total of 102 patients participated in this study. Eighty-four patients were male. The frequency distribution of DD, ID and II polymorphism were 23.6%, 62.7% and 13.7% respectively. There were no differences among genotypic groups in age, sex, number of risk factors, number of vein grafts and months since bypass surgery. According to adjusted Gensini score [0.18±0.12 (II) vs. 0.11±0.09 (ID) and 0.1±0.09 (DD) P=0.021] the II genotype was associated with severity of vein graft atherosclerosis.CONCLUSION Although there are conflicting results about gene angiotensin converting enzyme I/D polymorphism and the degree of venous bypass graft degeneration, this study suggests an association between ACE genotype II and atherosclerosis of saphenous vein grafts, however, large samples considering clinical, demographic and ethnic profile are necessary to confirm these results.

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Five-year outcomes following PCI with DES versus CABG for unprotected LM coronary lesions: meta-analysis and meta-regression of 2914 patients

Abstract: CABG surgery remains the best option of treatment for patients with ULMCA disease, with less need of TVR and MACCE rates at long-term follow-up.

Cited by 14 publications

References 19 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

Meta-analysis study comparing percutaneous coronary intervention/drug eluting stent versus coronary artery bypass surgery of unprotected left main coronary artery disease

Association of angiotensin converting enzyme genotype insertion/deletion polymorphism and saphenous vein graft atherosclerosis in Iranian patients

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