Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are associated with comparable survival rates among left main coronary artery disease (LMCAD) patients after 10 years, according to a new meta-analysis published in the American Journal of Cardiology. However, unplanned revascularizations were significantly more common among patients treated with PCI.
Citing “conflicting” studies on the long-term effects of choosing to treat LMCAD with PCI or CABG, the study’s authors explored data from five different randomized control trials. The meta-analysis included a total of 4,595 patients; 2,298 patients underwent CABG, and 2,297 patients underwent PCI. All PCI procedures, the group noted, were performed using first- or second-generation drug-eluting stents.
Overall, the 10-year cumulative risk of all-cause mortality was 11.2%. This broke down to 12% among PCI patients and 10.6% among CABG patients.
“We demonstrated that the difference in cumulative all-cause mortality at 10 years between PCI and CABG for LMCAD patients did not reach statistical significance,” wrote first author Nicholas W.S. Chew, MRCP, a cardiologist with the National University Health System in Singapore, and colleagues. “However, caution needs to be taken when applying these results because of the modest numerical difference in 10-year mortality between both revascularization strategies; patients undergoing PCI had nonsignificant 1.4% absolute increase and 12% relative increase in mortality risk compared with patients undergoing CABG.”
When it came to unplanned revascularizations after five years, however, CABG came out ahead. The rates were 15.1% among PCI patients and 8% among CABG patients.
“Our findings of increased unplanned revascularization in patients treated for PCI compared with patients treated for CABG are consistent with current evidence,” the authors wrote. “Despite the introduction of drug-eluting stents, bypass grafts offer a more durable solution in protecting long diseased coronaries that would take time to progress. Increased long-term unplanned revascularization in the PCI arm is an important consideration when choosing the appropriate revascularization strategy.”
CABG was also associated with a lower myocardial infarction rate (2.7%) than PCI (5%), but the overall difference was not found to be significant. The stroke rate was the exact same, 2.7%, for both treatment options.