Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidenceCentral MessagePerspective
Objectives: There is an ongoing debate whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is the better choice for treatment of left main (LM) stenosis. We aimed to provide external validation for the recently reviewed guideline recommendations for invasive LM...
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Elsevier
2024-12-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273624002730 |
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| author | Hristo Kirov, MD Tulio Caldonazo, MD Aryan D. Khayyat, MS Panagiotis Tasoudis, MD Johannes Fischer, MS Angelique Runkel, MS Murat Mukharyamov, MD Torsten Doenst, MD, PhD |
| author_facet | Hristo Kirov, MD Tulio Caldonazo, MD Aryan D. Khayyat, MS Panagiotis Tasoudis, MD Johannes Fischer, MS Angelique Runkel, MS Murat Mukharyamov, MD Torsten Doenst, MD, PhD |
| author_sort | Hristo Kirov, MD |
| collection | DOAJ |
| description | Objectives: There is an ongoing debate whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is the better choice for treatment of left main (LM) stenosis. We aimed to provide external validation for the recently reviewed guideline recommendations for invasive LM therapy by evaluating the impact of CABG or PCI on long-term survival from local reports of different regions in the world. We performed a systematic review and meta-analysis to address contemporary registry studies comparing PCI and CABG for patients with LM stenosis. Methods: Three databases were assessed. Our primary end point was long-term all-cause mortality. Secondary end points were major adverse cardiovascular events (MACE), myocardial infarction, repeat revascularization, stroke, and periprocedural mortality. Reconstruction of time-to-event data was performed. Results: A total of 2477 studies were retrieved. Seven studies with risk-adjusted populations were selected for the analysis. Four studies favored CABG and 3 studies showed no difference for the primary end point. Compared with PCI, patients who underwent CABG had lower risk of death (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26, P < .01) and MACE (hazard ratio, 1.54; 95% confidence interval, 1.40-1.69, P < .01) during follow-up. Moreover, PCI was associated with more myocardial infarction, repeat revascularization, but less strokes when compared with CABG. There was no significant difference regarding periprocedural mortality. The MACE rate was lower after CABG in both early and late phase, which outweighs the higher rate of periprocedural stroke after CABG. Conclusions: Regional registry evidence supports the current notion of superior long-term endpoints with CABG compared with PCI for the treatment of LM stenosis over time. |
| format | Article |
| id | doaj-art-e06eaab8d11f47e1bb4429bdcee9a2ef |
| institution | Kabale University |
| issn | 2666-2736 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj-art-e06eaab8d11f47e1bb4429bdcee9a2ef2024-12-15T06:17:00ZengElsevierJTCVS Open2666-27362024-12-0122257271Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidenceCentral MessagePerspectiveHristo Kirov, MD0Tulio Caldonazo, MD1Aryan D. Khayyat, MS2Panagiotis Tasoudis, MD3Johannes Fischer, MS4Angelique Runkel, MS5Murat Mukharyamov, MD6Torsten Doenst, MD, PhD7Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, GermanyDivision of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NCDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany; Address for reprints: Torsten Doenst, MD, PhD, Department of Cardiothoracic Surgery, University of Jena, Am Klinikum 1, Jena, 07747, Germany.Objectives: There is an ongoing debate whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is the better choice for treatment of left main (LM) stenosis. We aimed to provide external validation for the recently reviewed guideline recommendations for invasive LM therapy by evaluating the impact of CABG or PCI on long-term survival from local reports of different regions in the world. We performed a systematic review and meta-analysis to address contemporary registry studies comparing PCI and CABG for patients with LM stenosis. Methods: Three databases were assessed. Our primary end point was long-term all-cause mortality. Secondary end points were major adverse cardiovascular events (MACE), myocardial infarction, repeat revascularization, stroke, and periprocedural mortality. Reconstruction of time-to-event data was performed. Results: A total of 2477 studies were retrieved. Seven studies with risk-adjusted populations were selected for the analysis. Four studies favored CABG and 3 studies showed no difference for the primary end point. Compared with PCI, patients who underwent CABG had lower risk of death (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26, P < .01) and MACE (hazard ratio, 1.54; 95% confidence interval, 1.40-1.69, P < .01) during follow-up. Moreover, PCI was associated with more myocardial infarction, repeat revascularization, but less strokes when compared with CABG. There was no significant difference regarding periprocedural mortality. The MACE rate was lower after CABG in both early and late phase, which outweighs the higher rate of periprocedural stroke after CABG. Conclusions: Regional registry evidence supports the current notion of superior long-term endpoints with CABG compared with PCI for the treatment of LM stenosis over time.http://www.sciencedirect.com/science/article/pii/S2666273624002730percutaneous coronary interventioncoronary artery bypass graftingleft main coronary disease |
| spellingShingle | Hristo Kirov, MD Tulio Caldonazo, MD Aryan D. Khayyat, MS Panagiotis Tasoudis, MD Johannes Fischer, MS Angelique Runkel, MS Murat Mukharyamov, MD Torsten Doenst, MD, PhD Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidenceCentral MessagePerspective JTCVS Open percutaneous coronary intervention coronary artery bypass grafting left main coronary disease |
| title | Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidenceCentral MessagePerspective |
| title_full | Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidenceCentral MessagePerspective |
| title_fullStr | Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidenceCentral MessagePerspective |
| title_full_unstemmed | Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidenceCentral MessagePerspective |
| title_short | Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidenceCentral MessagePerspective |
| title_sort | comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidencecentral messageperspective |
| topic | percutaneous coronary intervention coronary artery bypass grafting left main coronary disease |
| url | http://www.sciencedirect.com/science/article/pii/S2666273624002730 |
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