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Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials

Author

Listed:
  • Luca Testa
  • Azeem Latib
  • Mario Bollati
  • Rocco Antonio Montone
  • Antonio Colombo
  • Filippo Crea
  • Francesco Bedogni

Abstract

Background: The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. Aim: The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. Methods: Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR). Results: We identified 6 Randomised Controlled Trials totalling 4717 patients allocated to PCI or CABG. At 1 year follow up, PCI and CABG were substantially equivalent with respect to the rates of MACE [PCI 8.5% vs CABG 8.9%, OR 1.02,(0.76–1.36), p = 0.9], death [PCI 5.4% vs CABG 6.6%, OR 0.81,(0.63–1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80(0.59–1.07), p = 0.14]. Notably, PCI was associated with a significantly lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17–0.79), p = 0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%, OR 2.00(1.46–2.75), p

Suggested Citation

  • Luca Testa & Azeem Latib & Mario Bollati & Rocco Antonio Montone & Antonio Colombo & Filippo Crea & Francesco Bedogni, 2017. "Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-12, June.
    • Handle: RePEc:plo:pone00:0179060
    DOI: 10.1371/journal.pone.0179060
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