CABG Surgery Remains the best Option for Patients with Left Main Coronary Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled Trials
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| Natura: | Artículo científico |
| Lingua: | en |
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Sociedade Brasileira de Cirurgia Cardiovascular
2017
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| _version_ | 1876433693758717952 |
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| author | Michel Pompeu Barros Oliveira Sá |
| author_facet | Michel Pompeu Barros Oliveira Sá |
| contents | CABG Surgery Remains the best Option for Patients with Left Main Coronary Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled Trials Michel Pompeu Barros Oliveira Sá Artur Freire Soares Rodrigo Gusmão Albuquerque Miranda Mayara Lopes Araújo Alexandre Motta Menezes Frederico Pires Vasconcelos Silva Ricardo Carvalho Lima Medicina Meta Drug Stents Analysis Eluting Stents Objective: To compare the safety and efficacy of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease. Methods: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for clinical studies that reported outcomes at 1-year follow-up after PCI with DES and CABG for the treatment of ULMCA stenosis. Five studies fulfilled our eligibility criteria and they included a total of 4.595 patients (2.298 for CABG and 2.297 for PCI with DES). Results: At 1-year follow-up, there was no significant difference between CABG and DES groups concerning the risk for death (risk ratio [RR] 0.973, P=0.830), myocardial infarction (RR 0.694, P=0.148), stroke (RR 1.224, P=0.598), and major adverse cerebrovascular and cardiovascular events (RR 0.948, P=0.680). The risk for target vessel revascularization (TVR) was significantly lower in the CABG group compared to the DES group (RR 0.583, P<0.001). It was observed no publication bias regarding the outcomes, but only the outcome TVR was free from substantial statistical heterogeneity of the effects. In the meta-regression, there was evidence that the factor “female gender” modulated the effect regarding myocardial infarction rates, favoring the CABG strategy. Conclusion: CABG surgery remains the best option of treatment for patients with ULMCA disease, with lower TVR rates. 2017 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398953453013 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.5 Vol.32 |
| format | Artículo científico |
| id | redalyc_398953453013 |
| institution | Redalyc |
| language | en |
| publishDate | 2017 |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| spellingShingle | CABG Surgery Remains the best Option for Patients with Left Main Coronary Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled Trials Michel Pompeu Barros Oliveira Sá Medicina Meta Drug Stents Analysis Eluting Stents CABG Surgery Remains the best Option for Patients with Left Main Coronary Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled Trials Michel Pompeu Barros Oliveira Sá Artur Freire Soares Rodrigo Gusmão Albuquerque Miranda Mayara Lopes Araújo Alexandre Motta Menezes Frederico Pires Vasconcelos Silva Ricardo Carvalho Lima Medicina Meta Drug Stents Analysis Eluting Stents Objective: To compare the safety and efficacy of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease. Methods: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for clinical studies that reported outcomes at 1-year follow-up after PCI with DES and CABG for the treatment of ULMCA stenosis. Five studies fulfilled our eligibility criteria and they included a total of 4.595 patients (2.298 for CABG and 2.297 for PCI with DES). Results: At 1-year follow-up, there was no significant difference between CABG and DES groups concerning the risk for death (risk ratio [RR] 0.973, P=0.830), myocardial infarction (RR 0.694, P=0.148), stroke (RR 1.224, P=0.598), and major adverse cerebrovascular and cardiovascular events (RR 0.948, P=0.680). The risk for target vessel revascularization (TVR) was significantly lower in the CABG group compared to the DES group (RR 0.583, P<0.001). It was observed no publication bias regarding the outcomes, but only the outcome TVR was free from substantial statistical heterogeneity of the effects. In the meta-regression, there was evidence that the factor “female gender” modulated the effect regarding myocardial infarction rates, favoring the CABG strategy. Conclusion: CABG surgery remains the best option of treatment for patients with ULMCA disease, with lower TVR rates. 2017 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398953453013 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.5 Vol.32 |
| title | CABG Surgery Remains the best Option for Patients with Left Main Coronary Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled Trials |
| topic | Medicina Meta Drug Stents Analysis Eluting Stents |
| url | https://www.redalyc.org/articulo.oa?id=398953453013 |