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Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease.

Publication ,  Journal Article
Garg, A; Rao, SV; Agrawal, S; Theodoropoulos, K; Mennuni, M; Sharma, A; Garg, L; Ferrante, G; Meelu, OA; Sargsyan, D; Reimers, B; Cohen, M ...
Published in: Am J Cardiol
June 15, 2017

Few randomized controlled trials (RCTs) and observational studies had shown acceptable short-term efficacy and safety of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) in selected patients with left main coronary artery disease (LMCAD). We aimed to evaluate long-term outcomes of PCI using DES compared with CABG in patients with LMCAD. On November 1, 2016, we searched available databases for published RCTs directly comparing DES PCI with CABG in patients with LMCAD. Odds ratios (ORs) were used as the metric of choice for treatment effects using a random-effects model. I-squared index was used to assess heterogeneity across trials. Prespecified end points were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, and repeat revascularization at maximal available follow-up. We identified 5 RCTs including a total of 4,595 patients, with a median follow-up of 60 months. The risk of all-cause mortality (OR 1.01; 95% confidence interval [CI] 0.76 to 1.34) and cardiovascular mortality (OR 1.02; 95% CI 0.73 to 1.42) were comparable between PCI with DES and CABG. Similarly, there were no statistically significant differences between PCI with DES and CABG for MI (OR 1.45; 95% CI 0.87 to 2.40) and stroke (OR 0.87; 95% CI 0.38 to 1.98). Conversely, repeat revascularization was significantly higher with PCI compared with CABG (OR 1.82; 95% CI 1.51 to 2.21). In conclusion, in patients with LMCAD, PCI with DES appears to be a viable alternative to CABG at long-term follow-up, with similar risks of ischemic adverse events (mortality, MI, and stroke) but a higher risk of repeat revascularization.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

June 15, 2017

Volume

119

Issue

12

Start / End Page

1942 / 1948

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Percutaneous Coronary Intervention
  • Drug-Eluting Stents
  • Coronary Vessels
  • Coronary Artery Disease
  • Coronary Artery Bypass
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Garg, A., Rao, S. V., Agrawal, S., Theodoropoulos, K., Mennuni, M., Sharma, A., … Stefanini, G. G. (2017). Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease. Am J Cardiol, 119(12), 1942–1948. https://doi.org/10.1016/j.amjcard.2017.03.019
Garg, Aakash, Sunil V. Rao, Sahil Agrawal, Kleanthis Theodoropoulos, Marco Mennuni, Abhishek Sharma, Lohit Garg, et al. “Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease.Am J Cardiol 119, no. 12 (June 15, 2017): 1942–48. https://doi.org/10.1016/j.amjcard.2017.03.019.
Garg, Aakash, et al. “Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease.Am J Cardiol, vol. 119, no. 12, June 2017, pp. 1942–48. Pubmed, doi:10.1016/j.amjcard.2017.03.019.
Garg A, Rao SV, Agrawal S, Theodoropoulos K, Mennuni M, Sharma A, Garg L, Ferrante G, Meelu OA, Sargsyan D, Reimers B, Cohen M, Kostis JB, Stefanini GG. Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease. Am J Cardiol. 2017 Jun 15;119(12):1942–1948.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

June 15, 2017

Volume

119

Issue

12

Start / End Page

1942 / 1948

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Percutaneous Coronary Intervention
  • Drug-Eluting Stents
  • Coronary Vessels
  • Coronary Artery Disease
  • Coronary Artery Bypass
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology