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Minerva Cardiology and Angiology 2021 June;69(3):313-21

DOI: 10.23736/S2724-5683.20.05370-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Long-term outcomes of percutaneous or surgical treatment in left main disease

Juan G. CHIABRANDO 1, 2 , Giovanni M. VESCOVO 3, Marco LOMBARDI 4, 5, Marco G. DEL BUONO 4, 5, Francisco J. ROMEO 1, Daniel H. BERROCAL 1, Luis GUZMAN 6, Giuseppe BIONDI-ZOCCAI 7, 8, Antonio ABBATE 4

1 Interventional Cardiology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2 Health Science Statistics Applied Laboratory (LEACS), Department of Pharmacology and Toxicology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; 3 Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy; 4 VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; 5 Department of Cardiovascular and Thoracic Sciences, Sacred Heart Catholic University, Rome, Italy; 6 Wake Forest University, Winston-Salem, NC, USA; 7 Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy; 8 Mediterranea Cardiocentro, Naples, Italy



INTRODUCTION: Long-term efficacy and safety of either surgical or percutaneous treatment left main coronary artery disease treatment is lacking.
EVIDENCE ACQUISITION: We conducted a systematic review and meta-analysis of the most updated randomized clinical trials that compared the efficacy of coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the Left Main Coronary Artery (LMCA) disease. It was also conducted a systematic search of PubMed, Google Scholar, reference lists of relevant articles, and Medline. The search utilized the following terms: “left main PCI versus CABG,” “drug-eluting stents,” “bypass surgery” and “left main stenting.” The search of articles compatible with our inclusion and exclusion criteria was performed from inception through April 2020 and returned a combined total of 304 articles.
EVIDENCE SYNTHESIS: We identified 6 studies, providing data on 5812 patients. The mean follow-up was 6.7 years. PCI was associated with an increased risk of major vascular events (MACE) (IRR 1.24, 95% CI [1.03-1.67], P<0.01), and coronary revascularization (IRR 1.69, 95% CI [1.42-2.03], P<0.01) compared to CABG. Furthermore, all-cause death, MI and stroke events were not statistically different between the two therapeutic revascularization methodologies (IRR 1.06, 95% CI [0.90-1.24], P=0.47, IRR 1.35, 95% CI [0.84-2.16], P=0.03 and IRR 0.66, 95% CI [0.43-1.01], P=0.05, respectively).
CONCLUSIONS: LMCA PCI has an overall same survival compared to CABG in the long term follow-up. Nevertheless, MACE and revascularization events were more frequent in PCI compared to CABG.


KEY WORDS: Coronary artery disease; Percutaneous coronary intervention; Coronary Artery Bypass; Meta-analysis

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