Skip to main content
main-content

01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Medicine 1/2017

Percutaneous intervention versus coronary artery bypass graft surgery in left main coronary artery stenosis: a systematic review and meta-analysis

Zeitschrift:
BMC Medicine > Ausgabe 1/2017
Autoren:
Xin-Lin Zhang, Qing-Qing Zhu, Jing-Jing Yang, Yu-Han Chen, Yang Li, Su-Hui Zhu, Jun Xie, Lian Wang, Li-Na Kang, Biao Xu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12916-017-0853-1) contains supplementary material, which is available to authorized users.

Abstract

Background

The optimal revascularization technique in patients with left main coronary artery disease (CAD) remains controversial. We aimed to compare the long-term performance of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in treatment of left main CAD.

Methods

PubMed, EMBASE, and the Cochrane Library were searched until November 16, 2016.

Results

Six randomized controlled trials and 22 matched observational studies including 22,487 patients and 90,167 patient-years of follow-up were included. PCI was associated with an overall higher risk for the major adverse cardiac and cerebrovascular events (hazard ratio (HR), 1.42; 95% confidence interval (CI), 1.14–1.77), mainly driven by higher rates of myocardial infarction (HR, 1.69; 95% CI, 1.22–2.34) and revascularization (HR, 2.80; 95% CI, 1.86–4.22). The overall risks for all-cause death (HR, 1.05; 95% CI, 0.93–1.20), cardiac death (HR, 1.05; 95% CI, 0.69–1.59), stroke (HR, 0.64; 95% CI, 0.33–1.24), and the composite safety endpoint of death, myocardial infarction, or stroke (HR, 1.06; 95% CI, 0.97–1.16) were similar between PCI and CABG. Stratified analysis based on stent types showed that the increased risk for myocardial infarction associated with PCI was only evident in patients with bare-metal stents or early-generation drug-eluting stents (DES), but not newer-generation DES. Stratified analyses based on study designs showed largely similar findings with the overall analyses, except for a significantly higher incidence of myocardial infarction in adjusted studies (HR, 2.01; 95% CI, 1.64–2.45) but a trend toward higher incidence in randomized trials (HR, 1.39; 95% CI, 0.85–2.27) associated with PCI.

Conclusions

Compared with CABG, PCI with newer-generation DES might be a safe alternative revascularization strategy for treatment of left main CAD, but is associated with more repeat revascularization.
Zusatzmaterial
Additional file 1: PRISMA checklist. (DOCX 29 kb)
12916_2017_853_MOESM1_ESM.docx
Additional file 2: Supplemental information. (DOCX 1488 kb)
12916_2017_853_MOESM2_ESM.docx
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2017

BMC Medicine 1/2017 Zur Ausgabe


 

Neu im Fachgebiet Allgemeinmedizin

Meistgelesene Bücher aus dem Fachgebiet

2018 | Buch

Repetitorium Geriatrie

Geriatrische Grundversorgung - Zusatz-Weiterbildung Geriatrie - Schwerpunktbezeichnung Geriatrie

Das vorliegende Werk orientiert sich an den Fort-bzw. Weiterbildungsinhalten der Zusatz-Weiterbildung „Geriatrie“ , der Schwerpunktbezeichnung „Geriatrie“ sowie der strukturierten curricularen Fortbildung „Geriatrische Grundversorgung“ und wendet …

Herausgeber:
Dr. Rainer Neubart

2012 | Buch

Häufige Hautkrankheiten in der Allgemeinmedizin

Klinik Diagnose Therapie

Patienten mit Hautkrankheiten machen einen großen Anteil der Patienten in der Allgemeinarztpraxis aus. Prägnante Texte und zahlreiche Abbildungen zu Klinik, Pathogenese, Diagnose und Therapie helfen, die häufigsten dermatologischen Probleme zu lösen.

Autor:
Prof. Dr. med. Dietrich Abeck

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Allgemeinmedizin und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise