Drug-Eluting Stents Versus Coronary Artery Bypass Grafts for Left Main Coronary Disease: A Meta-Analysis and Review of Randomised Controlled Trials
Revascularisation of left main coronary artery (LMCA) disease can be potentially managed with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Recent randomised controlled trial (RCT) data have added to the literature on this subject and this meta-analysis aim...
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| Veröffentlicht in: | Heart, lung & circulation lung & circulation, 2018-12, Vol.27 (12), p.1437-1445 |
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| creator | Moore, Peter Burrage, Matthew Garrahy, Paul Lim, Richard McCann, Andrew Camuglia, Anthony |
| description | Revascularisation of left main coronary artery (LMCA) disease can be potentially managed with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Recent randomised controlled trial (RCT) data have added to the literature on this subject and this meta-analysis aims to assess the state of the data to assist in guiding patient treatment decisions.
A systematic literature search of Cochrane Library, EMBASE, OVID, and PubMed Medline was performed. Randomised controlled trials of patients with LMCA disease undergoing PCI with drug eluting stents or CABG were included. Clinical outcomes and adverse events were assessed and analysed.
Four suitable RCTs of adequate quality and follow-up were identified. The incidence of major adverse cardiac and cerebrovascular events (MACCE) at 3 to 5 years of follow-up was significantly increased with PCI compared to CABG (23.3% vs 18.2%, OR 1.37; 95% CI: 1.18–1.58; p= |
| doi_str_mv | 10.1016/j.hlc.2017.09.008 |
| format | Article |
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A systematic literature search of Cochrane Library, EMBASE, OVID, and PubMed Medline was performed. Randomised controlled trials of patients with LMCA disease undergoing PCI with drug eluting stents or CABG were included. Clinical outcomes and adverse events were assessed and analysed.
Four suitable RCTs of adequate quality and follow-up were identified. The incidence of major adverse cardiac and cerebrovascular events (MACCE) at 3 to 5 years of follow-up was significantly increased with PCI compared to CABG (23.3% vs 18.2%, OR 1.37; 95% CI: 1.18–1.58; p=<0.0001; I2=0%) and was largely driven by more repeat revascularisation procedures among patients treated with PCI. There was no statistically significant difference in rates of mortality, myocardial infarction or stroke (either individually or when these outcomes were combined as a composite endpoint).
Coronary artery bypass grafting and PCI both represent reasonable treatment modalities for LMCA disease in appropriately selected patients. However, where CABG is feasible it offers superior long-term freedom from repeat revascularisation. Longer-term follow-up is required to further clarify the durability of mortality outcomes, especially in patients treated with PCI.</description><identifier>ISSN: 1443-9506</identifier><identifier>EISSN: 1444-2892</identifier><identifier>DOI: 10.1016/j.hlc.2017.09.008</identifier><identifier>PMID: 29102437</identifier><language>eng</language><publisher>Australia: Elsevier B.V</publisher><subject>Coronary Artery Bypass - methods ; Coronary artery bypass graft surgery ; Coronary Artery Disease - surgery ; Coronary Vessels - surgery ; Decision Making ; Drug-Eluting Stents ; Humans ; Ischaemic heart disease ; Left main coronary artery disease ; Percutaneous coronary intervention ; Percutaneous Coronary Intervention - methods ; Randomized Controlled Trials as Topic</subject><ispartof>Heart, lung & circulation, 2018-12, Vol.27 (12), p.1437-1445</ispartof><rights>2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)</rights><rights>Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-13f7b8cabb7ce4aca422ee97f2b1171a509b8f4790b59c021914eae13bc6c9f03</citedby><cites>FETCH-LOGICAL-c353t-13f7b8cabb7ce4aca422ee97f2b1171a509b8f4790b59c021914eae13bc6c9f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.hlc.2017.09.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29102437$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moore, Peter</creatorcontrib><creatorcontrib>Burrage, Matthew</creatorcontrib><creatorcontrib>Garrahy, Paul</creatorcontrib><creatorcontrib>Lim, Richard</creatorcontrib><creatorcontrib>McCann, Andrew</creatorcontrib><creatorcontrib>Camuglia, Anthony</creatorcontrib><title>Drug-Eluting Stents Versus Coronary Artery Bypass Grafts for Left Main Coronary Disease: A Meta-Analysis and Review of Randomised Controlled Trials</title><title>Heart, lung & circulation</title><addtitle>Heart Lung Circ</addtitle><description>Revascularisation of left main coronary artery (LMCA) disease can be potentially managed with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Recent randomised controlled trial (RCT) data have added to the literature on this subject and this meta-analysis aims to assess the state of the data to assist in guiding patient treatment decisions.
A systematic literature search of Cochrane Library, EMBASE, OVID, and PubMed Medline was performed. Randomised controlled trials of patients with LMCA disease undergoing PCI with drug eluting stents or CABG were included. Clinical outcomes and adverse events were assessed and analysed.
Four suitable RCTs of adequate quality and follow-up were identified. The incidence of major adverse cardiac and cerebrovascular events (MACCE) at 3 to 5 years of follow-up was significantly increased with PCI compared to CABG (23.3% vs 18.2%, OR 1.37; 95% CI: 1.18–1.58; p=<0.0001; I2=0%) and was largely driven by more repeat revascularisation procedures among patients treated with PCI. There was no statistically significant difference in rates of mortality, myocardial infarction or stroke (either individually or when these outcomes were combined as a composite endpoint).
Coronary artery bypass grafting and PCI both represent reasonable treatment modalities for LMCA disease in appropriately selected patients. However, where CABG is feasible it offers superior long-term freedom from repeat revascularisation. Longer-term follow-up is required to further clarify the durability of mortality outcomes, especially in patients treated with PCI.</description><subject>Coronary Artery Bypass - methods</subject><subject>Coronary artery bypass graft surgery</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary Vessels - surgery</subject><subject>Decision Making</subject><subject>Drug-Eluting Stents</subject><subject>Humans</subject><subject>Ischaemic heart disease</subject><subject>Left main coronary artery disease</subject><subject>Percutaneous coronary intervention</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Randomized Controlled Trials as Topic</subject><issn>1443-9506</issn><issn>1444-2892</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1uEzEUhS0EoqXwAGyQl2xm8F9mYliFtBSkVEilsLU8nuviaGIHXw8oz8EL45ICO1bnWvrOke89hDznrOWMd6-27dfJtYLxvmW6ZWz5gJxypVQjllo8_D3LRi9Yd0KeIG5ZBZXUj8mJ0JwJJftT8vM8z7fNxTSXEG_ppwKxIP0CGWek65RTtPlAV7lAlbeHvUWkl9n6CvmU6QZ8oVc2xH_seUCwCK_pil5Bsc0q2umAAamNI72G7wF-0OTpdX2mXWXHao0lp2mq400OdsKn5JGvAs_u9Yx8fndxs37fbD5eflivNo2TC1kaLn0_LJ0dht6Bss4qIQB078XAec_tgulh6VWv2bDQjgmuuQILXA6uc9ozeUZeHnP3OX2bAYupH3IwTTZCmtFw3XEmRSdkRfkRdTkhZvBmn8Ou7ms4M3ddmK2pXZi7LgzTpnZRPS_u4-dhB-Nfx5_jV-DNEYC6ZD1MNugCRAdjyOCKGVP4T_wvDKSbmQ</recordid><startdate>201812</startdate><enddate>201812</enddate><creator>Moore, Peter</creator><creator>Burrage, Matthew</creator><creator>Garrahy, Paul</creator><creator>Lim, Richard</creator><creator>McCann, Andrew</creator><creator>Camuglia, Anthony</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201812</creationdate><title>Drug-Eluting Stents Versus Coronary Artery Bypass Grafts for Left Main Coronary Disease: A Meta-Analysis and Review of Randomised Controlled Trials</title><author>Moore, Peter ; Burrage, Matthew ; Garrahy, Paul ; Lim, Richard ; McCann, Andrew ; Camuglia, Anthony</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-13f7b8cabb7ce4aca422ee97f2b1171a509b8f4790b59c021914eae13bc6c9f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Coronary Artery Bypass - methods</topic><topic>Coronary artery bypass graft surgery</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary Vessels - surgery</topic><topic>Decision Making</topic><topic>Drug-Eluting Stents</topic><topic>Humans</topic><topic>Ischaemic heart disease</topic><topic>Left main coronary artery disease</topic><topic>Percutaneous coronary intervention</topic><topic>Percutaneous Coronary Intervention - methods</topic><topic>Randomized Controlled Trials as Topic</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moore, Peter</creatorcontrib><creatorcontrib>Burrage, Matthew</creatorcontrib><creatorcontrib>Garrahy, Paul</creatorcontrib><creatorcontrib>Lim, Richard</creatorcontrib><creatorcontrib>McCann, Andrew</creatorcontrib><creatorcontrib>Camuglia, Anthony</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart, lung & circulation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moore, Peter</au><au>Burrage, Matthew</au><au>Garrahy, Paul</au><au>Lim, Richard</au><au>McCann, Andrew</au><au>Camuglia, Anthony</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Drug-Eluting Stents Versus Coronary Artery Bypass Grafts for Left Main Coronary Disease: A Meta-Analysis and Review of Randomised Controlled Trials</atitle><jtitle>Heart, lung & circulation</jtitle><addtitle>Heart Lung Circ</addtitle><date>2018-12</date><risdate>2018</risdate><volume>27</volume><issue>12</issue><spage>1437</spage><epage>1445</epage><pages>1437-1445</pages><issn>1443-9506</issn><eissn>1444-2892</eissn><abstract>Revascularisation of left main coronary artery (LMCA) disease can be potentially managed with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Recent randomised controlled trial (RCT) data have added to the literature on this subject and this meta-analysis aims to assess the state of the data to assist in guiding patient treatment decisions.
A systematic literature search of Cochrane Library, EMBASE, OVID, and PubMed Medline was performed. Randomised controlled trials of patients with LMCA disease undergoing PCI with drug eluting stents or CABG were included. Clinical outcomes and adverse events were assessed and analysed.
Four suitable RCTs of adequate quality and follow-up were identified. The incidence of major adverse cardiac and cerebrovascular events (MACCE) at 3 to 5 years of follow-up was significantly increased with PCI compared to CABG (23.3% vs 18.2%, OR 1.37; 95% CI: 1.18–1.58; p=<0.0001; I2=0%) and was largely driven by more repeat revascularisation procedures among patients treated with PCI. There was no statistically significant difference in rates of mortality, myocardial infarction or stroke (either individually or when these outcomes were combined as a composite endpoint).
Coronary artery bypass grafting and PCI both represent reasonable treatment modalities for LMCA disease in appropriately selected patients. However, where CABG is feasible it offers superior long-term freedom from repeat revascularisation. Longer-term follow-up is required to further clarify the durability of mortality outcomes, especially in patients treated with PCI.</abstract><cop>Australia</cop><pub>Elsevier B.V</pub><pmid>29102437</pmid><doi>10.1016/j.hlc.2017.09.008</doi><tpages>9</tpages></addata></record> |
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| subjects | Coronary Artery Bypass - methods Coronary artery bypass graft surgery Coronary Artery Disease - surgery Coronary Vessels - surgery Decision Making Drug-Eluting Stents Humans Ischaemic heart disease Left main coronary artery disease Percutaneous coronary intervention Percutaneous Coronary Intervention - methods Randomized Controlled Trials as Topic |
| title | Drug-Eluting Stents Versus Coronary Artery Bypass Grafts for Left Main Coronary Disease: A Meta-Analysis and Review of Randomised Controlled Trials |
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