Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials

L Testa, A Latib, Mario Bollati, RA Montone, A Colombo, Fillipo Crea, Francesco Bedogni

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Abstract

Background The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. Aim The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR). Results We identified 6 Randomised Controlled Trials totalling 4717 patients allocated to PCI or CABG. At 1 year follow up, PCI and CABG were substantially equivalent with respect to the rates of MACE [PCI 8.5% vs CABG 8.9%, OR 1.02,(0.76–1.36), p = 0.9] , death [PCI 5.4% vs CABG 6.6%, OR 0.81,(0.63–1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80 (0.59–1.07), p = 0.14] . Notably, PCI was associated with a significantly lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17–0.79), p = 0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%, OR 2.00(1.46–2.75), p <0.01]. At a median follow up of 5years, the rates of MACE were similar between the two strategies: PCI 14.6% vs CABG 13.8%, OR 1.02(0.76–1.38), p = 0.89. Likewise, the rates of death [PCI 8% and CABG 7.7%, OR 1(0.77–1.31), P = 0.9] , MI [PCI 6.1% vs CABG 5%, OR 1.41(0.85–2.34), P = 0.19, I 2 59%], and stroke [PCI 2% vs CABG 2.2%, OR 0.85(0.42–1.81), p = 0.65,] were similar while PCI was associated with a significantly higher rate of TVR [14.5% vs CABG 8.9%, OR 1.73(1.41–2.13), p <0.01]. Conclusion In patients with UPLM disease, PCI and CABG are associated with similar rates of MACE and mortality at 1 year as well as after 5 years. Differences can be detected for individual end points at both short and long term FU. © 2017 Testa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Original languageEnglish
Article numbere0179060
JournalPLoS One
Volume12
Issue number6
DOIs
Publication statusPublished - 2017

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systematic review
coronary vessels
Percutaneous Coronary Intervention
stroke
meta-analysis
Coronary Artery Bypass
Meta-Analysis
Randomized Controlled Trials
Stroke
death
Mortality
Licensure
PubMed
Reproduction
Cause of Death
Safety
Therapeutics
methodology

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Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials. / Testa, L; Latib, A; Bollati, Mario; Montone, RA; Colombo, A; Crea, Fillipo; Bedogni, Francesco.

In: PLoS One, Vol. 12, No. 6, e0179060, 2017.

Research output: Contribution to journalArticle

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title = "Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials",
abstract = "Background The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. Aim The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR). Results We identified 6 Randomised Controlled Trials totalling 4717 patients allocated to PCI or CABG. At 1 year follow up, PCI and CABG were substantially equivalent with respect to the rates of MACE [PCI 8.5{\%} vs CABG 8.9{\%}, OR 1.02,(0.76–1.36), p = 0.9] , death [PCI 5.4{\%} vs CABG 6.6{\%}, OR 0.81,(0.63–1.03),p = 0.08] and MI [PCI 3.4{\%} vs CABG 4.3{\%}, OR 0.80 (0.59–1.07), p = 0.14] . Notably, PCI was associated with a significantly lower rate of stroke [PCI 0.6{\%} vs CABG 1.8{\%}, OR 0.36,(0.17–0.79), p = 0.01] and with a significantly higher rate of TVR [PCI 8.7{\%} vs CABG 4.5{\%}, OR 2.00(1.46–2.75), p <0.01]. At a median follow up of 5years, the rates of MACE were similar between the two strategies: PCI 14.6{\%} vs CABG 13.8{\%}, OR 1.02(0.76–1.38), p = 0.89. Likewise, the rates of death [PCI 8{\%} and CABG 7.7{\%}, OR 1(0.77–1.31), P = 0.9] , MI [PCI 6.1{\%} vs CABG 5{\%}, OR 1.41(0.85–2.34), P = 0.19, I 2 59{\%}], and stroke [PCI 2{\%} vs CABG 2.2{\%}, OR 0.85(0.42–1.81), p = 0.65,] were similar while PCI was associated with a significantly higher rate of TVR [14.5{\%} vs CABG 8.9{\%}, OR 1.73(1.41–2.13), p <0.01]. Conclusion In patients with UPLM disease, PCI and CABG are associated with similar rates of MACE and mortality at 1 year as well as after 5 years. Differences can be detected for individual end points at both short and long term FU. {\circledC} 2017 Testa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",
author = "L Testa and A Latib and Mario Bollati and RA Montone and A Colombo and Fillipo Crea and Francesco Bedogni",
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T1 - Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials

AU - Testa, L

AU - Latib, A

AU - Bollati, Mario

AU - Montone, RA

AU - Colombo, A

AU - Crea, Fillipo

AU - Bedogni, Francesco

PY - 2017

Y1 - 2017

N2 - Background The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. Aim The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR). Results We identified 6 Randomised Controlled Trials totalling 4717 patients allocated to PCI or CABG. At 1 year follow up, PCI and CABG were substantially equivalent with respect to the rates of MACE [PCI 8.5% vs CABG 8.9%, OR 1.02,(0.76–1.36), p = 0.9] , death [PCI 5.4% vs CABG 6.6%, OR 0.81,(0.63–1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80 (0.59–1.07), p = 0.14] . Notably, PCI was associated with a significantly lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17–0.79), p = 0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%, OR 2.00(1.46–2.75), p <0.01]. At a median follow up of 5years, the rates of MACE were similar between the two strategies: PCI 14.6% vs CABG 13.8%, OR 1.02(0.76–1.38), p = 0.89. Likewise, the rates of death [PCI 8% and CABG 7.7%, OR 1(0.77–1.31), P = 0.9] , MI [PCI 6.1% vs CABG 5%, OR 1.41(0.85–2.34), P = 0.19, I 2 59%], and stroke [PCI 2% vs CABG 2.2%, OR 0.85(0.42–1.81), p = 0.65,] were similar while PCI was associated with a significantly higher rate of TVR [14.5% vs CABG 8.9%, OR 1.73(1.41–2.13), p <0.01]. Conclusion In patients with UPLM disease, PCI and CABG are associated with similar rates of MACE and mortality at 1 year as well as after 5 years. Differences can be detected for individual end points at both short and long term FU. © 2017 Testa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

AB - Background The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. Aim The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR). Results We identified 6 Randomised Controlled Trials totalling 4717 patients allocated to PCI or CABG. At 1 year follow up, PCI and CABG were substantially equivalent with respect to the rates of MACE [PCI 8.5% vs CABG 8.9%, OR 1.02,(0.76–1.36), p = 0.9] , death [PCI 5.4% vs CABG 6.6%, OR 0.81,(0.63–1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80 (0.59–1.07), p = 0.14] . Notably, PCI was associated with a significantly lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17–0.79), p = 0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%, OR 2.00(1.46–2.75), p <0.01]. At a median follow up of 5years, the rates of MACE were similar between the two strategies: PCI 14.6% vs CABG 13.8%, OR 1.02(0.76–1.38), p = 0.89. Likewise, the rates of death [PCI 8% and CABG 7.7%, OR 1(0.77–1.31), P = 0.9] , MI [PCI 6.1% vs CABG 5%, OR 1.41(0.85–2.34), P = 0.19, I 2 59%], and stroke [PCI 2% vs CABG 2.2%, OR 0.85(0.42–1.81), p = 0.65,] were similar while PCI was associated with a significantly higher rate of TVR [14.5% vs CABG 8.9%, OR 1.73(1.41–2.13), p <0.01]. Conclusion In patients with UPLM disease, PCI and CABG are associated with similar rates of MACE and mortality at 1 year as well as after 5 years. Differences can be detected for individual end points at both short and long term FU. © 2017 Testa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

U2 - 10.1371/journal.pone.0179060

DO - 10.1371/journal.pone.0179060

M3 - Article

VL - 12

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 6

M1 - e0179060

ER -