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Higher safety results found in PCI vs. CABG
Capodanno D. J Am Coll Cardiol. 2011;58:1426-1432.
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Nonsignificantly different 1-year rates of major adverse cardiac and cerebrovascular events, death, MI, a reduced risk for stroke and a higher risk for target vessel revascularization were associated more with percutaneous coronary intervention than CABG in patients with left main coronary artery disease.
Searching Medline and Cochrane databases from January 1980 to April 2011, researchers identified four randomized clinical trials that included a study population of left main CAD, randomization to PCI vs. CABG, and a report of safety and efficacy outcomes. Primary endpoints were 1-year incidence of major adverse cardiac and cerebrovascular events, defined as death, MI, target vessel revascularization or stroke.
Across the four studies, there were 1,611 patients, 809 of whom were assigned to PCI, and 802 to CABG. Overall, researchers found a nonsignificant trend toward a higher risk for major adverse cardiac and cerebrovascular events with PCI vs. CABG (OR=1.28; 95% CI, 0.95-1.72), and PCI had a higher 1-year rate of target vessel revascularization (OR=2.25; 95% CI, 1.54-3.29). In 71% of patients treated with PCI, complete revascularization was achieved vs. 76% of patients treated with CABG. In patients treated with PCI, researchers found a less frequent occurrence of cerebrovascular accident vs. CABG, as well as stroke (OR=0.15; 95% CI, 0.03-0.67). Overall, researchers found no significant differences in death (OR=0.74; 95% CI, 0.43-1.29) or MI (OR=0.98; 95% CI, 0.54-1.78), according to study results.
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