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Minerva Cardioangiologica 2020 Nov 04

DOI: 10.23736/S0026-4725.20.05370-0


lingua: Inglese

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, Giuseppe BIONDI-ZOCCAI 6, 7, Luis GUZMAN 8, Antonio ABBATE 4

1 Interventional Cardiology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2 Health Science Statistics Applied Laboratory (LEACS), Pharmacology and Toxicology Department, 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, Catholic University of the Sacred Heart, Rome, Italy; 6 Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; 7 Mediterranea Cardiocentro, Napoli, Italy; 8 Wake Forest University, NC, USA


BACKGROUND: Long term efficacy and safety of either surgical or percutaneous treatment left main coronary artery disease treatment is lacking.
METHODS: 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.
RESULTS: 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% confidence interval (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: Left main; Percutaneous coronary intervention; Coronary artery bypass surgery; Meta-analysis

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