Long term outcomes of percutaneous or surgical treatment in left main disease.

Abstract

BACKGROUND Long term efficacy and safety of either surgical or percutaneous treatment left main coronary artery disease treatment is lacking. METHODS We conducted a systematic review and meta-analysis of the most updated randomized clinical trials that compared the efficacy of coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the Left Main Coronary Artery (LMCA) disease. RESULTS We identified 6 studies, providing data on 5812 patients. The mean follow-up was 6.7 years. PCI was associated with an increased risk of major vascular events (MACE) (IRR 1.24, 95% confidence interval (CI) [1.03-1.67], p<0.01), and coronary revascularization (IRR 1.69, 95% CI [1.42-2.03], p<0.01) compared to CABG. Furthermore, all-cause death, MI and stroke events were not statistically different between the two therapeutic revascularization methodologies (IRR 1.06, 95% CI [0.90-1.24], p=0.47, IRR 1.35, 95% CI [0.84-2.16], p=0.03 and IRR 0.66, 95% CI [0.43-1.01], p=0.05, respectively). CONCLUSIONS LMCA PCI has an overall same survival compared to CABG in the long term follow up. Nevertheless, MACE and revascularization events were more frequent in PCI compared to CABG.