Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regression

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention Pub Date : 2025-01-09 DOI:10.1016/j.ijcrp.2025.200370

Muhammad Hamza Shuja , Firzah Shakil , Syed Hassaan Ali , Qazi Shurjeel Uddin , Ayesha Noman , Javed Iqbal , Muhammad Ahmed , Faiza Sajid , Haya Waseem Ansari , Syed Ahmed Farhan , Huzaifa Ul Haq Ansari , Syed Husain Farhan , Muhammad Moiz Nasir , Sana Qazi , Muhammad Majid

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Abstract

Background

Previous studies suggest similar cardiovascular (CV) benefits for either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD). However, limited data exist on the influence of prior cerebrovascular disease (CEVD). Thus, we aim to compare the CV outcomes in patients with LMCAD and prior CEVD, undergoing either PCI or CABG.

Methods

A comprehensive search from (January 2000 to August 2024) identified three relevant studies. Outcomes analyzed included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), and risk of stroke in patients undergoing either PCI or CABG for LMCAD. Data analysis employed a random effects model and presented hazard ratios (HR) along with their 95 % confidence intervals (CI).

Results

Three studies involving 760 patients (361 PCI, 399 CABG) were included. PCI was associated with a significantly higher risk of MACCE (HR = 2.56; 95 % CI = 1.23–5.37; p = 0.01; I² = 86 %) and MI (HR = 2.97; 95 % CI = 1.72–5.13; p < 0.0001; I² = 0 %) compared to CABG. No significant differences were observed in all-cause mortality (HR = 1.35; 95 % CI = 0.92–1.98; p = 0.12; I² = 0 %) or recurrent stroke (HR = 0.83; 95 % CI = 0.40–1.70; p = 0.60; I² = 1 %). The risk of repeat revascularization was higher in PCI, though not statistically significant (HR = 3.44; 95 % CI = 0.50–23.60; p = 0.21; I² = 70 %).

Conclusion

PCI significantly elevates the risk of MACCE and MI in patients with LMCAD and prior CEVD compared to CABG. However, risks of all-cause mortality, repeat stroke, and revascularization were non-significant. Comorbidities may drive the elevated risk, underscoring the need for tailored strategies in this population.

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经皮冠状动脉介入治疗与冠状动脉旁路移植术治疗既往脑血管疾病患者左主干病变的比较：系统回顾、meta分析和meta回归

背景：先前的研究表明，对于左主干冠状动脉疾病（LMCAD）患者，经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）对心血管（CV）的益处相似。然而，关于既往脑血管病（CEVD）影响的数据有限。因此，我们的目的是比较LMCAD患者和既往CEVD患者的CV结果，接受PCI或CABG。方法：综合检索2000年1月至2024年8月期间的3项相关研究。分析的结果包括全因死亡率、主要不良心脑血管事件（MACCE）、心肌梗死（MI）和接受PCI或CABG治疗LMCAD患者的卒中风险。数据分析采用随机效应模型，并给出了风险比（HR）及其95%置信区间（CI）。结果：纳入3项研究，共760例患者（361例PCI， 399例CABG）。PCI与MACCE发生风险显著增高相关(HR = 2.56；95% ci = 1.23-5.37；p = 0.01；I2 = 86%)和MI (HR = 2.97；95% ci = 1.72-5.13；p 2 = 0 %)。两组全因死亡率无显著差异(HR = 1.35；95% ci = 0.92-1.98；p = 0.12；I2 = 0%)或卒中复发(HR = 0.83；95% ci = 0.40-1.70；p = 0.60；i2 = 1%)。PCI组重复血运重建的风险较高，但无统计学意义(HR = 3.44；95% ci = 0.50-23.60；p = 0.21；i2 = 70%)。结论：与CABG相比，LMCAD和既往CEVD患者PCI明显增加MACCE和MI的风险。然而，全因死亡率、重复卒中和血运重建术的风险无统计学意义。合并症可能会导致风险升高，因此需要针对这一人群制定量身定制的策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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