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JACC April 5, 2016

Volume 67, Issue 13

ACC.i2 Interventional Cardiology

LONG TERM OUTCOMES IN PATIENTS WITH LEFT MAIN CORONARY ARTERY DISEASE TREATED
WITH EITHER PERCUTANEOUS CORONARY INTERVENTION OR BYPASS SURGERY-EVIDENCE FROM
A META-ANALYSIS
Poster Contributions
Poster Area, South Hall A1
Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m.
Session Title: Complex PCI: Left Main, Multi Vessel, Bifurcation
Abstract Category: 8. ACC.i2 Interventional Cardiology: Coronary Intervention: Left Main, Multivessel, Bifurcation
Presentation Number: 1107-156
Authors: Partha Sardar, Saurav Chatterjee, Amartya Kundu, Ramez Nairooz, Khaled Tuwairqi, Riyaz Bashir, Brian ONeill, Brian OMurchu,
Debabrata Mukherjee, Jay Giri, Howard Cohen, Theophilus Owan, University of Utah, Salt Lake City, UT, USA
Background: Long term benefits of percutaneous coronary intervention (PCI) for left main disease compared to coronary artery bypass
grafting (CABG) remain controversial. This analysis was performed to determine 5-year outcomes of PCI compared with CABG, for the
treatment of left main coronary artery (LMCA) stenosis.

Methods: Databases were searched from January 2000 and August 2015. Randomized controlled trials and observational studies
comparing PCI versus CABG for LMCA stenosis were identified. We calculated summary odds ratios (ORs) and 95% Confidence Intervals
(CI) with the random-effects model. The primary outcome of interest was all cause mortality.

Results: The analysis included 4,546 patients from 7 studies (2 randomized controlled trials and 5 observational studies). Compared to the
CABG group, patients who underwent PCI had a significantly lower risk of all cause mortality [OR 0.77; 95% CI 0.61 to 0.97] and stroke
[OR 0.38; 95% CI 0.21 to 0.68]. The 5-year risk of myocardial infarction (MI) [OR 1.32; 95% CI 0.74 to 2.37] and the combined risk of
death, MI, or stroke [OR 0.76; 95% CI 0.55 to 1.04] were not significantly different for patients undergoing PCI versus CABG. The risk of
target vessel revascularization (TVR) was significantly higher in the PCI group than in the CABG group [OR 4.10; 95% CI 2.55 to 6.59].
Conclusions: Five years follow up data suggests that, in selected patients, PCI with DES is a safe and effective alternative to CABG for
revascularization of LMCA stenosis.

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