Upadhaya Sunil, Baniya Ramkaji, Madala Seetharamprasad, Subedi Suresh Kumar, Khan Jahangir, Velagapudi Ravi Kanth, Bachuwa Ghassan
Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan.
J Card Surg. 2017 Feb;32(2):70-79. doi: 10.1111/jocs.13090. Epub 2017 Jan 12.
Coronary artery bypass grafting (CABG) is the standard of care for treating left main coronary lesions. However, recently published randomized controlled trials (RCT) have shown conflicting results. We sought to compare clinical outcomes of percutaneous coronary intervention (PCI) with drug-eluting stent placement to CABG using a meta-analysis of randomized controlled trials.
A systemic search of Pubmed, Scopus, Cochrane library, and Clinicaltrials.gov was performed for randomized controlled trials comparing PCI with CABG in patients with left main stenosis. Data were analyzed using random effect models and Mantel-Haenszel methods. The primary outcome was major adverse cardiovascular and cerebral events (MACCE). The secondary outcomes were myocardial infarction, stroke, cardiac, and all-cause mortality. A subgroup analysis based on SYNTAX score was also performed.
A total of 4595 patients (2297 in the PCI group and 2298 in the CABG group) from five RCTs were included in the analysis. There were significant differences in MACCE (odds ratio [OR] 1.36, confidence interval [CI] 95%, 1.18-1.58, p-value: < 0.0001) and repeat revascularization (OR 1.85, CI 95%, 1.53-2.23, p-value: < 0.00001) favoring CABG. There were no significant differences in the incidence of myocardial infarction, stroke, or cardiac and all-cause mortality. Based on SYNTAX score, CABG was superior in terms of MACCE only in the subgroup with SYNTAX score of 33 or more.
CABG results in fewer MACCE and need for repeat revascularization than PCI in patients with unprotected left main disease.
冠状动脉旁路移植术（CABG）是治疗左主干冠状动脉病变的标准治疗方法。然而，最近发表的随机对照试验（RCT）结果相互矛盾。我们试图通过对随机对照试验的荟萃分析，比较经皮冠状动脉介入治疗（PCI）联合药物洗脱支架置入术与CABG的临床结局。
对PubMed、Scopus、Cochrane图书馆和Clinicaltrials.gov进行系统检索，以查找比较PCI与CABG治疗左主干狭窄患者的随机对照试验。使用随机效应模型和Mantel-Haenszel方法分析数据。主要结局是主要不良心血管和脑血管事件（MACCE）。次要结局是心肌梗死、中风、心脏和全因死亡率。还进行了基于SYNTAX评分的亚组分析。
分析纳入了来自五项RCT的4595例患者（PCI组2297例，CABG组2298例）。MACCE（优势比[OR]1.36，95%置信区间[CI]，1.18 - 1.58，p值：<0.0001）和再次血运重建（OR 1.85，95%CI，1.53 - 2.23，p值：<0.00001）存在显著差异，CABG更具优势。心肌梗死、中风、心脏和全因死亡率的发生率无显著差异。基于SYNTAX评分，仅在SYNTAX评分为33或更高的亚组中，CABG在MACCE方面更具优势。
在无保护左主干病变患者中，CABG导致的MACCE和再次血运重建需求少于PCI。
