University of Oulu

Laukkanen JA, Kunutsor SK, Niemelä M, et al. All-cause mortality and major cardiovascular outcomes comparing percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: a meta-analysis of short-term and long-term randomised trials. Open Heart 2017;4:e000638. doi: 10.1136/openhrt-2017-000638

All-cause mortality and major cardiovascular outcomes comparing percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis : a meta-analysis of short-term and long-term randomised trials

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Author: Laukkanen, Jari A1,2; Kunutsor, Setor K3; Niemelä, Matti4;
Organizations: 1Institute of Clinical Medicine, University of Eastern Finland
2Division of Cardiology, Department of Medicine, Central Finland Central Hospital
3Translational Health Sciences, Bristol Medical School, University of Bristol
4Division of Cardiology, Department of Internal Medicine, Oulu University Hospital
5Department of Cardiology, Aalborg University Hospital
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.4 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe201802093293
Language: English
Published: BMJ, 2017
Publish Date: 2018-02-09
Description:

Abstract

Objective: We compared percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) for the treatment of left main coronary artery (LMCA) disease by conducting a systematic review and meta-analysis of randomised controlled trials (RCTs).

Methods: RCTs of PCI versus CABG in patients with LMCA stenosis were identified from MEDLINE, the Cochrane Library and search of bibliographies to November 2016. Study-specific HRs with 95% CIs were aggregated for all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), and other cardiovascular events at time points of 30 days, 1 year and 3 years and beyond.

Results: Six RCTs comprising 4700 patients were included. There were no significant differences in risk of all-cause mortality in pooled analysis of relevant trials at 30 days (0.61, 95% CI 0.27 to 1.36), 1 year (0.66, 95% CI 0.42 to 1.04), and 3 years and beyond (1.04, 95% CI 0.81 to 1.33), comparing PCI with CABG. There was no significant difference in the risk of MACCE at 30 days (0.72, 95% CI 0.51 to 1.03) and 1 year (1.16, 95% CI 0.94 to 1.44); however, PCI was associated with a higher risk of MACCE compared with CABG during longer-term follow-up (1.27, 95% CI 1.12 to 1.44). Composite outcome of death, stroke or myocardial infarction was lower with PCI at 30 days (0.67, 95% CI 0.49 to 0.92). Repeat revascularisation was increased at 1 year and at 3 years and beyond for PCI.

Conclusions: All-cause mortality rates are not significantly different between PCI and CABG at short-term and long-term follow-up. However, PCI is associated with a reduction in the risk of major cardiovascular outcomes at short-term follow-up in patients with LMCA stenosis; but at long term, MACCE rate is increased for PCI.

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Series: Open heart
ISSN: 2398-595X
ISSN-E: 2053-3624
ISSN-L: 2398-595X
Volume: 4
Issue: 2
Article number: e000638
DOI: 10.1136/openhrt-2017-000638
OADOI: https://oadoi.org/10.1136/openhrt-2017-000638
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 Internal medicine
3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Copyright information: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
  https://creativecommons.org/licenses/by-nc/4.0/