Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta‐analysis of randomized controlled trials

Sharma, Sharan Prakash; Dahal, Khagendra; Khatra, Jaspreet; Rosenfeld, Alan; Lee, Juyoung

doi:10.1111/1755-5922.12260

Cited by 6 publications

(4 citation statements)

References 49 publications

(108 reference statements)

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“…This finding of non-inferiority of CABG at five years contrasts with the findings of two earlier systematic reviews [ 3 , 30 ]. A more recent study that included the same RCTs as this review, however, concurs with our observation [ 10 ].…”

Section: Reviewsupporting

confidence: 91%

“…This systematic review is the first to include the five-year data from the large EXCEL trial, as well as the 10year follow-up data from the Le MANS, PRECOMBAT, and SYNTAX trials [10,[24][25][26][27]. This expanded data provides a comprehensive view of the long-term outcomes of both interventions in LMCA disease.…”

Section: Discussionmentioning

confidence: 99%

“…This may be due to the heterogeneity of the studies included with many systematic reviews including both randomised control trials as well as retrospective observational studies in the same analysis [7][8][9]. Other reviews have excluded key trials or have included too few outcomes or follow-up time points in their analysis [10][11][12]. Another issue may be variation in surgical or interventional techniques such as the use of drug-eluting stents as well as more general technical or surgical developments over time.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease: An Updated Systematic Review and Meta-Analysis

Hennessy,

Henry,

Parameswaran

et al. 2023

Cureus

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Recently, both US and European guidelines have predominantly recommended coronary artery bypass grafting (CABG) as the preferred revascularisation method. However, emerging data have raised the possibility of percutaneous coronary intervention (PCI) being a viable and effective alternative. This metaanalysis sought to evaluate the latest insights from major clinical trials to ascertain whether PCI could be as effective as CABG in treating left main coronary artery (LMCA) disease.To achieve this, a comprehensive systematic search was conducted across databases, including Medline (via PubMed), Embase, Cochrane, and clinicaltrials.gov. The search spanned from the inception of these databases to August 20, 2022, and exclusively focused on randomized controlled trials (RCTs). Employing the random effects model, selected studies underwent rigorous analysis. The study outcomes encompassed a spectrum of factors such as all-cause mortality, major adverse cerebrovascular and cardiovascular events (MACCE), myocardial infarction (MI), stroke, and revascularisation procedures. The observation periods of interest included the 30-day mark, 1 year, 5 years, and 10 years.The analysis integrated six RCTs, revealing noteworthy patterns. In terms of all-cause mortality, PCI demonstrated non-inferiority to CABG across all observed time frames: 30 days (OR 0.6), 1 year (OR 0.77), 5 years (OR 1.41), and 10 years (OR 1.08). Analysis of MACCE outcomes favored PCI at 30 days and CABG at 5 years. The utilisation of the original five-year EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularisation) trial definition for MI highlighted higher MI rates for PCI compared to CABG (OR 1.66, P < 0.05). Intriguingly, when the subsequently released EXCEL data, aligned with the third universal MI definition, was incorporated, the five-year data consistently leaned towards CABG. Specifically, the PCI group exhibited 7.5% MI rates in contrast to the 3.6% in the CABG cohort (OR 2.19, P < 0.001). Concerning stroke, PCI proved advantageous at 30 days and 1 year while exhibiting no significant disparity at 5 and 10 years. Revascularisation procedures favoured CABG at one and five years, with comparability at the remaining time points.In summation, the outcomes of this comprehensive meta-analysis suggest that PCI could serve as a feasible alternative to CABG in the context of uncomplicated LMCA disease. It's worth noting that CABG might still hold an advantage for complex lesions.

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Section: Reviewsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease: An Updated Systematic Review and Meta-Analysis

Hennessy,

Henry,

Parameswaran

et al. 2023

Cureus

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“…Stents [5,6] and metal plates [7,8] are the most commonly used metal implants. To investigate biocompatibility of promising metal alloys (for example, titanium nickelide), it is required to implant medical device prototypes made of the above alloys into laboratory animals, which is followed by assessment of connective tissue capsule formation, infiltration by immunocompetent cells and neovascularization [9,10].…”

Section: Introductionmentioning

confidence: 99%

A Novel Technique for Preparation, Staining, and Visualization of Tissue with Metal Implants and Extraskeletal Calcification Areas

Mukhamadiyarov¹,

Богданов²,

Мишинов³

et al. 2020

Sovrem Tehnol Med

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The aim of the study was to evaluate the efficacy of a novel technique for preparation, staining, and visualization of tissues containing extra-skeletal mineralization areas, all-metal implants or their prototypes for their subsequent examination using scanning electron microscopy in the backscattered electron mode. Materials and Methods. After fixation in 10% formalin (24 h), the biomaterial (a titanium nickelide plate with the surrounding tissues after subcutaneous implantation, patented titanium alloy plates with the surrounding tissues after cranioplasty, primary and secondary calcified atherosclerotic plaques) were fixed with 1% osmium tetroxide (12 h) and then stained with 2% aqueous solution of osmium tetroxide (48 h). The samples were further stained with 2% alcoholic uranyl acetate (5 h), dehydrated with isopropanol (5 h) and acetone (1 h), impregnated with a mixture of acetone and epoxy resin Epon (1:1, 6 h) and then embedded into a fresh portion of epoxy resin (24 h), which was followed by polymerization at 60°C. After grinding and polishing, epoxy blocks were counterstained with lead citrate (7 min) and sputter-coated with carbon, then the samples were visualized by scanning electron microscopy in the backscattered electron mode. The elemental composition was studied using X-ray microanalysis. Results. The developed technique allows obtaining high-quality images at five thousand-fold magnifications, provides the possibility to identify the shape and structure of intact metal and mineral inclusions, and to type the surrounding cells, distinguishing mesenchymal and immunocompetent cells by shape and cytoplasmic content. Apart from connective tissue capsule thickness and leukocyte infiltration, this technique makes it possible to estimate the number and area of newly formed small-caliber vessels representing a surrogate marker of inflammation. Conclusion. The proposed technique provides the possibility to investigate adequately the structure of samples when their sectioning is impossible or significantly complicated, with image quality remarkably higher than that obtained by light microscopy.

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Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery Stenosis

Wang

Zhan

Bao

et al. 2019

The American Journal of the Medical Sciences

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Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta‐analysis of randomized controlled trials

Abstract: Percutaneous coronary intervention could be as safe and effective as CABG in a select group of left main coronary artery disease patients.

Cited by 6 publications

References 49 publications

Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease: An Updated Systematic Review and Meta-Analysis

Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease: An Updated Systematic Review and Meta-Analysis

A Novel Technique for Preparation, Staining, and Visualization of Tissue with Metal Implants and Extraskeletal Calcification Areas

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery Stenosis

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