Stent versus Coronary Artery Bypass Surgery in Multi-Vessel and Left Main Coronary Artery Disease: A Meta-Analysis of Randomized Trials with Subgroups Evaluation

Abstract

Background Comparison between percutaneous coronary intervention (PCI) using stents and Coronary Artery Bypass Grafting (CABG) remains controversial. Objective To conduct a systematic review with meta-analysis of PCI using Stents versus CABG in randomized controlled trials. Methods Electronic databases were searched to identify randomized trials comparing PCI using Stents versus CABG for multi-vessel and unprotected left main coronary artery disease (LMCAD). 15 trials were found and their results were pooled. Differences between trials were considered significant if p < 0.05. Results In the pooled data (n = 12,781), 30 days mortality and stroke were lower with PCI (1% versus 1.7%, p = 0.01 and 0.6% versus 1.7% p < 0.0001); There was no difference in one and two year mortality (3.3% versus 3.7%, p = 0.25; 6.3% versus 6.0%, p = 0.5). Long term mortality favored CABG (10.6% versus 9.4%, p = 0.04), particularly in trials of DES era (10.1% versus 8.5%, p = 0.01). In diabetics (n = 3,274) long term mortality favored CABG (13.7% versus 10.3%; p < 0.0001). In six trials of LMCAD (n = 4,700) there was no difference in 30 day mortality (0.6%versus 1.1%, p = 0.15), one year mortality (3% versus 3.7%, p = 0.18), and long term mortality (8.1% versus 8.1%) between PCI and CABG; the incidence of stroke was lower with PCI (0.3% versus 1.5%; p < 0.001). Diabetes and a high SYNTAX score were the subgroups that influenced more adversely the results of PCI. Conclusion Compared with CABG, PCI using Stents showed lower 30 days mortality, higher late mortality and lower incidence of stroke. Diabetes and a high SYNTAX were the subgroups that influenced more adversely the results of PCI.

Short and Intermediate Term Clinical Outcomes of Patients with Unprotected Left Main Coronary Artery Stenting

“…However, PCI had a lower incidence of stroke than CABG (0.3% versus 1.5%, P-value 0.001). The two factors that had the most negative effects on PCI findings were diabetes and having a high SYNTAX score (33) .…”

Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus

“…Most of the evidence regarding revascularization of patients with DM and left main disease has been obtained from subgroup analyses of clinical trials, as no study to date has focused only on this population (25). Although being the best available evidence to date, these results should be analyzed with caution, especially because they may not be properly powered for the subgroup with DM (26).…”

Intervenção Percutânea da Artéria Coronária Principal Esquerda. Por que os Dados do Mundo Real são tão Importantes?

“…[2][3][4][5][6] Recently, these data were compiled in two meta-analysis where long term follow-up has shown no significant difference in mortality and stroke rate between PCI and CABG. 7,8 In addition, two of these randomized trials with extended long-term followup, up to 10 years, have demonstrated sustained good results after PCI, with death rates similar to CABG, respectively, 14.5% x 13.8% and 27% x 28%. 4,5 In this issue of Arquivos Brasileiros de Cardiologia, Grion et al 9 present their experience with PCI for ULMCA disease in a consecutive series of 107 patients.…”