Drug-eluting stents versus coronary artery bypass grafting for left-main coronary artery disease

被引:4
|
作者
Takagi, Hisato [1 ]
Ando, Tomo [2 ]
Umemoto, Takuya [1 ]
机构
[1] Shizuoka Med Ctr, Dept Cardiovasc Surg, Shizuoka 4118611, Japan
[2] Detroit Med Ctr, Dept Cardiol, Detroit, MI USA
关键词
drug-eluting stents; coronary artery bypass grafting; left-main coronary artery disease; meta-analysis; LONG-TERM OUTCOMES; BARE-METAL STENTS; 5-YEAR OUTCOMES; INTERVENTION; METAANALYSIS; SURGERY; STENOSIS; IMPLANTATION; REVASCULARIZATION; ANGIOPLASTY;
D O I
10.1002/ccd.27235
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
ObjectivesTo compare follow-up outcomes after percutaneous coronary intervention with drug-eluting stents (DES-PCI) versus coronary artery bypass grafting (CABG) for left-main coronary artery disease (LMCAD), we performed a meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity-score analysis. MethodsMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through November 2016. Eligible studies were RCTs or observational studies with propensity-score analysis of DES-PCI versus CABG enrolling patients with LMCAD and reporting6-month mortality, myocardial infarction (MI), stroke, or repeat revascularization (RRV). Study-specific estimates were combined using inverse variance-weighted averages of logarithmic hazard ratios (HRs) in the random-effects model. ResultsWe identified 5 RCTs and 17 observational studies with propensity-score analysis enrolling a total of 12,387 patients. Pooled analysis demonstrated a significant increase in a composite of death, MI, and RRV (with/without stroke) after DES-PCI (HR, 1.42; P<0.00001); no significant difference in a composite of death and MI (with/without stroke); no significant differences in mortality and stroke; a strong trend toward an increase in MI after DES-PCI (HR, 1.44; P=0.05); and significant increases in any (HR, 1.86; P<0.00001), target-vessel (HR, 3.28; P<0.00001), and target-lesion RRV (HR, 2.26; P=0.003) after DES-PCI. ConclusionsWhen compared with CABG, DES-PCI for LMCAD was associated with increases in RRV and the composite of death, MI, and RRV (with/without stroke), despite no differences in mortality, MI, stroke, and the composite of death and MI (with/without stroke).
引用
收藏
页码:697 / 709
页数:13
相关论文
共 50 条
  • [1] Use of Drug-Eluting Stents or Coronary Artery Bypass Grafting in Patients With Unprotected Left Main Coronary Artery Disease
    Alam, Mahboob
    AMERICAN JOURNAL OF CARDIOLOGY, 2013, 111 (06): : 921 - 922
  • [2] Left Main Coronary Artery Stenosis A Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting
    Athappan, Ganesh
    Patvardhan, Eshan
    Tuzcu, Murat E.
    Ellis, Stephen
    Whitlow, Patrick
    Kapadia, Samir R.
    JACC-CARDIOVASCULAR INTERVENTIONS, 2013, 6 (12) : 1219 - 1230
  • [3] The Use of Drug-Eluting Stents Versus Bypass Surgery for Left Main Coronary Artery Disease
    Eric L. Wallace
    David J. Moliterno
    Current Cardiology Reports, 2011, 13 (5) : 361 - 363
  • [4] Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Narrowing
    Sardar, Partha
    Giri, Jay
    Elmariah, Sammy
    Chatterjee, Saurav
    Kolte, Dhaval
    Kundu, Amartya
    Nairooz, Ramez
    Aronow, Wilbert S.
    Owan, Theophilus
    Mukherjee, Debabrata
    Feldman, Dmitriy N.
    Abbott, J. Dawn
    AMERICAN JOURNAL OF CARDIOLOGY, 2017, 119 (11): : 1746 - 1752
  • [5] Coronary artery bypass grafting following in-stent restenosis of drug-eluting stents deployed in the left main coronary artery
    Kanemitsu, Shinji
    Tanaka, Keizo
    Tanaka, Jin
    Suzuki, Hitoshi
    Kinoshita, Toshihiko
    CIRCULATION JOURNAL, 2008, 72 (03) : 502 - 504
  • [6] Stents versus coronary-artery bypass grafting for left main coronary artery disease
    Seung, Ki Bae
    Park, Duk-Woo
    Kim, Young-Hak
    Lee, Seung-Whan
    Lee, Cheol Whan
    Hong, Myeong-Ki
    Park, Seong-Wook
    Yun, Sung-Cheol
    Gwon, Hyeon-Cheol
    Jeong, Myung-Ho
    Jang, Yangsoo
    Kim, Hyo-Soo
    Kim, Pum Joon
    Seong, In-Whan
    Park, Hun Sik
    Ahn, Taehoon
    Chae, In-Ho
    Tahk, Seung-Jea
    Chung, Wook-Sung
    Park, Seung-Jung
    NEW ENGLAND JOURNAL OF MEDICINE, 2008, 358 (17): : 1781 - 1792
  • [7] FIVE-YEAR OUTCOMES AFTER DRUG-ELUTING STENTS VERSUS CORONARY-ARTERY BYPASS GRAFTING IN UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE
    Park, Duk Woo
    Lee, Jong-Young
    Kim, Won-Jang
    Oh, Junhyok
    Ahn, Jung-Min
    Song, Haegeun
    Kang, Soo-Jin
    Lee, Seung-Whan
    Kim, Young-Hak
    Lee, Cheol Whan
    Park, Seong-Wook
    Park, Seung-Jung
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 55 (10)
  • [8] Drug-Eluting Stents versus Coronary-Artery Bypass Grafting for Multivessel Coronary Artery Disease in Patients With Diabetes
    Li, Yan
    Zheng, Zhe
    Xu, Bo
    Zhang, Shiju
    Li, Wei
    Gao, Runlin
    Hu, Shengshou
    CIRCULATION, 2009, 120 (18) : S983 - S983
  • [10] Comparison of Percutaneous Coronary Intervention (With Drug-Eluting Stents) Versus Coronary Artery Bypass Grafting in Women With Severe Narrowing of the Left Main Coronary Artery (from the Women-Drug-Eluting stent for LefT main coronary Artery disease Registry)
    Buchanan, Gill Louise
    Chieffo, Alaide
    Meliga, Emanuele
    Mehran, Roxana
    Park, Seung-Jung
    Onuma, Yoshinobu
    Capranzano, Piera
    Valgimigli, Marco
    Narbute, Inga
    Makkar, Raj R.
    Palacios, Igor F.
    Kim, Young-Hak
    Buszman, Piotr P.
    Chakravarty, Tarun
    Sheiban, Imad
    Naber, Christoph
    Margey, Ronan
    Agnihotri, Arvind
    Marra, Sebastiano
    Capodanno, Davide
    Allgar, Victoria
    Leon, Martin B.
    Moses, Jeffrey W.
    Fajadet, Jean
    Lefevre, Thierry
    Morice, Marie-Claude
    Erglis, Andrejs
    Tamburino, Corrado
    Alfieri, Ottavio
    Serruys, Patrick W.
    Colombo, Antonio
    AMERICAN JOURNAL OF CARDIOLOGY, 2014, 113 (08): : 1348 - 1355