title: Meta-Analysis of Percutaneous Coronary Intervention With Drug-Eluting Stent Versus Coronary Artery Bypass Grafting for Isolated Proximal Left Anterior Descending Coronary Disease.
abstract: We performed a meta-analysis of the studies comparing the efficacy and safety of coronary artery bypass surgery against percutaneous coronary intervention with drug-eluting stents (PCI-DES) in patients with isolated LAD disease. Because of the limited randomized trial data, the optimal revascularization strategy for patients with isolated LAD disease remains uncertain. Using MEDLINE and EMBASE to source data, 11 studies (3 randomized trials and 8 cohort studies) including 5,044 participants were identified. No significant difference in mortality between PCI-DES and coronary artery bypass surgery (CABG; 111 of 2,122 [5.2%] and 120 of 2,574 [4.7%]; relative risk [RR] 1.23; 95% confidence interval [CI] 0.90 to 1.69) was detected. For MACE, PCI-DES was associated with significant increase in adverse events (RR 1.41; 95% CI 1.03 to 1.93, 8 studies, 4,230 participants). There were no significant differences in the risk of myocardial infarction (RR 0.86; 95% CI 0.58 to 1.26) or stroke (RR 2.36; 95% CI 0.54 to 10.43) between the 2 groups. There were 239 target vessel revascularization (TVR) events among 2,237 participants in the PCI-DES group (10.7%) and 145 TVR events among 2,793 participants in the CABG group (5.2%) with a significant increased risk of TVR in the PCI group (RR 2.52; 95% CI 1.69 to 3.77, 5,030 participants) compared with CABG. In conclusion, for patients with isolated disease of the LAD, meta-analysis of the available data suggests revascularization with a PCI-DES strategy offers similar mortality, MI, and stroke rates to CABG at the expense of increased TVR. Much of the data are derived from registries using first-generation DES, and further randomized trials with more contemporary platforms are needed.
authors.affiliation: Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom. Electronic address: tim.kinnaird2@wales.nhs.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
authors.affiliation: Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom.
authors.forename: Aditya
authors.initials: A
authors.lastname: Narain
authors.affiliation: Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom.
authors.forename: Rob
authors.initials: R
authors.lastname: Butler
authors.affiliation: Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ossei-Gerning
authors.affiliation: Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: Department of Cardiothoracic Surgery, Royal Brompton Hospital, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Moat
authors.affiliation: Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Anderson
authors.affiliation: Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome