title: Late stroke: comparison of percutaneous coronary intervention versus coronary artery bypass grafting in patients with multivessel disease and unprotected left main disease: a meta-analysis and review of literature.
abstract: OBJECTIVE
  Studies have suggested that the early excess risk of stroke in coronary artery bypass grafting (CABG) may be compensated for by a slow but progressive catch-up phenomenon in patients undergoing percutaneous coronary intervention (PCI). We therefore undertook this analysis to compare the temporal stroke risk between PCI and CABG in patients with unprotected left main stenosis and multivessel coronary artery disease.
  
  
  METHODS
  Studies of PCI versus CABG for unprotected left main stenosis and multivessel disease published between January 1994 (stent era) and July 2013 were identified using an electronic search and reviewed using meta-analytic techniques.
  
  
  RESULTS
  We selected 57 reports for the meta-analysis by applying the inclusion and exclusion criteria. The analysis was performed on 80,314 patient records. There was a significantly lower risk of cumulative stroke in patients undergoing PCI with stenting at 1 year (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.42-0.71), 2 years (OR, 0.78; 95% CI, 0.66-0.92), 3 years (OR, 0.79; 95% CI, 0.67-0.92), 4 years (OR, 0.74; 95% CI, 0.56-0.97), and 5 years (OR, 0.79; 95% CI, 0.69-0.91). There was no significant difference in the incidence of stroke because of the small sample size (OR, 0.71; 95% CI, 0.46-1.08) at >5 years between PCI and CABG. Similar results were observed on subgroup analysis (multi-vessel coronary artery disease, unprotected left main, diabetics, and randomized trials) and for stroke within 30 days. Late stroke (stroke>30 days) was similar between the 2 groups.
  
  
  CONCLUSIONS
  There is a significantly lower risk of stroke within 30 days and cumulative stroke with PCI as compared with CABG up to year 5. There is no late catch up of stroke in the PCI arm. The risk of stroke should be weighed in deciding between revascularization strategies.
authors.affiliation: From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Case Western Reserve University, MetroHealth Campus, Cleveland, OH (G.A., P.C.); Department of Cardiovascular Medicine, Tufts School of Medicine, Boston, MA (E.P.); and Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (R.D.G., E.M.T., S.R.K.).
authors.forename: Ganesh
authors.initials: G
authors.lastname: Athappan
authors.forename: Paul
authors.initials: P
authors.lastname: Chacko
authors.forename: Eshan
authors.initials: E
authors.lastname: Patvardhan
authors.forename: Rama Dilip
authors.initials: RD
authors.lastname: Gajulapalli
authors.forename: Emin Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D017130:Angioplasty; D002543:Cerebral Hemorrhage; D001026:Coronary Artery Bypass; D023381:Endpoint Determination; D005500:Follow-Up Studies; D006801:Humans; D009204:Myocardial Revascularization; D016017:Odds Ratio; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*
keywords: coronary artery bypass; percutaneous coronary intervention; stroke