Drug-eluting stents Versus Coronary Artery Bypass Grafting in Multivessel Disease and Left Main Obstruction: Meta-analysis of Randomized Clinical Trials

Andrade, Pedro José Negreiros de; Rocha, Hermano Alexandre Lima; Falcão, João Luiz de Alencar Araripe; Andrade, Antonio Thomaz de; Falcão, Breno de Alencar Araripe

doi:10.5935/2359-4802.20180005

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“…On the other side, modern meta-analysis included a lower number of trials (only of DES era) and evaluated specific group of patients. 28-32 The objective of this study was to perform a systematic review of RCT comparing stents (bare-metal and drug-eluting) versus CABG in multi-vessel and/or left main coronary disease (LMCAD) pooling data of mortality at different periods of time and using meta-regression analysis to evaluate sub-groups.…”

Section: Introductionmentioning

confidence: 99%

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

Andrade¹,

Falcão²,

Falcão³

et al. 2019

Arquivos Brasileiros De Cardiologia

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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.

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Section: Introductionmentioning

confidence: 99%