TDNet Discover

Background: The standard in current literature for left main coronary artery treatment is coronary artery bypass graft surgery (CABG). Another option that has come about the last few decades is percutaneous coronary intervention (PCI). However, the long term outcomes of PCI have yet to be established. Purpose: The research sought to determine if PCI could be used in place of CABG with similar 3-5 year outcomes for revascularization. Methods: An evidence-based clinical review (EBCR) was conducted by 3 researchers who performed a search and review process to find studies with the highest quality and level of evidence. Researchers searched three databases with specific phrases, inclusion, and exclusion criteria. These searches were tracked and recorded on an Excel spreadsheet. The researchers used a quality assessment tool to include and eliminate studies, narrowing it to three studies. Data extraction of the selected articles was performed to increase internal validity and reduce bias. Results: Across the three peer-reviewed articles in this analysis, PCI vs CABG showed no significant differences in overall major adverse cardiac events in a 3–5-year period except with the incidence of distal left main coronary artery stenosis where CABG has provided a stronger benefit. In De Filippo et al, PCI was associated with a higher risk of major adverse coronary events (MACE) in distal ULMCA disease with a hazard ratio (HR),1.32 [95% confidence interval (CI), 1.10-1.58], and P <.01). However, there was no significant difference in MACE for PCI or CABG for ostial/shaft stenosis with an HR, 1.00 (95% confidence interval, 0.79-1.27), and P = .99. In Sharma et al, five-year major adverse cardiac and cerebrovascular events (MACCE) favored CABG over PCI with a rate of 24% vs 18% and 95% CI, 1.19 to 1.76. In the subgroup analysis of studies reporting ≥ 3 years of follow-up, while there was no difference iv between CABG and PCI in the low-to-intermediate SYNTAX group, the benefit of CABG over PCI was maintained in the high SYNTAX group. For rate of revascularization, Sharma et al found CABG at an advantage to PCI at five-year follow-up (15.9% vs 9.9%;95% CI: 1.36-2.20;P < .0001). Stone et al also found PCI to have higher incidence of repeat revascularization compared to CABG with a rate of 16.9% vs. 10.0% with a 95% CI, 3.7 to 10.0. Conclusion: Based on the data presented in this research, PCI could potentially be used in place of CABG for the treatment of left main disease. There was no significant difference between PCI and CABG for left main disease in MACE, except for distal left main disease where CABG reduced MACE outcomes. In addition, PCI showed a slightly higher risk of repeat revascularization than CABG across all the studies.