Meta-analysis of Percutaneous Coronary Intervention with Drug Eluting Stent Versus Coronary Artery Bypass Grafting for Isolated Proximal Left Anterior Descending Coronary Disease

Mamas

Abstract

We performed a meta-analysis of the studies comparing the efficacy and safety of coronary artery bypass surgery (CABG) against percutaneous coronary intervention with drug-eluting stents (PCI-DES) among patients with isolated LAD disease. Due to limited randomised trial data the optimal revascularisation strategy for patients with isolated LAD disease remains uncertain. Using MEDLINE and EMBASE to source data 11 articles (3 randomized trials and 8 cohort studies) including 5,044 participants were identified. No significant difference in mortality between PCI-DES to CABG (111/2,122 (5.2%) and 120/2,574 (4.7%); RR 1.23;95%CI 0.90-1.69) was detected. For MACE, PCI-DES was associated with significant increase in adverse events (RR 1.41;95%CI 1.03-1.93, 8 studies, 4,230 participants). There were no significant differences in the risk of myocardial infarction (RR 0.86;95%CI 0.58-1.26) or stroke (RR 2.36;95%CI 0.54-10.43) between the two groups. There were 239 TVR events among 2,237 participants in the PCI-DES group (10.7%), and 145 TVR events among 2,793 participants in the CABG group (5.2%) with a significant increase risk of TVR in the PCI group (RR 2.52;95%CI 1.69-3.77, 5,030 participants) compared to CABG. In conclusion, for patients with isolated disease of the LAD, meta-analysis of the available data suggests revascularization with a PCI-DES strategy offers similar mortality, MI and stroke rates to CABG at the expense of increased TVR. Much of the data is derived from registries using first generation DES and further randomized trials with more contemporary platforms are needed.

Citation

Mamas. (2016). Meta-analysis of Percutaneous Coronary Intervention with Drug Eluting Stent Versus Coronary Artery Bypass Grafting for Isolated Proximal Left Anterior Descending Coronary Disease. American Journal of Cardiology, 1171-1177. https://doi.org/10.1016/j.amjcard.2016.07.030

• Acceptance Date: Jul 21, 2016
• Publication Date: Jul 29, 2016
• Journal: American Journal of Cardiology
• Print ISSN: 0002-9149
• Publisher: Elsevier
• Pages: 1171-1177
• DOI: https://doi.org/10.1016/j.amjcard.2016.07.030
• Keywords: percutaneous coronary intervention; drug-eluting stents; coronary artery bypass graft; proximal left anterior descending artery
• Publisher URL: https://doi.org/10.1016/j.amjcard.2016.07.030