Journal article
Intermediate and Late Outcomes With PCI vs CABG for Left Main Disease — Landmark Meta-Analysis of Randomized Trials
Cardiovascular revascularization medicine, Vol.23, pp.114-118
02/2021
DOI: 10.1016/j.carrev.2020.08.040
PMID: 32921597
Abstract
PCI to improve survival is currently recommended as a reasonable alternative to CABG in patients with unprotected left main disease. However, RCTs to support this recommendation has generated mixed results and recently published EXCEL trial has sparked debate about differences in late mortality. To address this point, we performed landmark meta-analysis of 4 RCTs with 5 year follow up data — EXCEL, NOBLE, PRECOMBAT and SYNTAX LEFT MAIN. Overall, there was no significant difference in all-cause mortality between PCI and CABG at 5 years (RR = 1.03 [95% CI = 0.79–1.33]). However, there was apparent change in the direction of association before and after the 1 year landmark that underscores the need for long term follow up in these trials. In addition, we found that PCI was associated with significantly lower rate of intermediate stroke at 1 year (RR = 0.44 [0.24–0.82]) but higher rate of late MI after 1 year (3.31 [2.11–5.18]) compared to CABG.
•No significant mortality difference at 5 years between PCI and CABG for unprotected left main disease.•There was however change in the direction of association after 1 year that underscores the need for long term follow up.•PCI was associated with lower rate of intermediate stroke at 1 year but higher rate of late MI after 1 year compared to CABG.
Details
- Title: Subtitle
- Intermediate and Late Outcomes With PCI vs CABG for Left Main Disease — Landmark Meta-Analysis of Randomized Trials
- Creators
- Emmanuel Akintoye - University of Iowa Hospitals and ClinicsMohamed Salih - University of Iowa Hospitals and ClinicsOlakanmi Olagoke - John H. Stroger, Jr. Hospital of Cook CountyAbdullahi Oseni - University of Iowa Hospitals and ClinicsPhanicharan Sistla - University of Iowa Hospitals and ClinicsMusab Alqasrawi - University of Iowa Hospitals and ClinicsAnthony Panos - University of Iowa Hospitals and ClinicsSidakpal Panaich - University of Iowa Hospitals and ClinicsFrank Sellke - Brown University
- Resource Type
- Journal article
- Publication Details
- Cardiovascular revascularization medicine, Vol.23, pp.114-118
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.carrev.2020.08.040
- PMID
- 32921597
- ISSN
- 1553-8389
- eISSN
- 1878-0938
- Language
- English
- Date published
- 02/2021
- Academic Unit
- Cardiovascular Medicine; Cardiothoracic Surgery; Internal Medicine
- Record Identifier
- 9984322818402771
Metrics
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