All-cause mortality is comparable in patients with left main coronary artery disease treated with PCI or CABG

Reference

Sabatine MS, Bergmark BA, Murphy SA, et al. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis. Lancet 2021;398(10318):2247-2257

Synopsis

This team searched several databases and identified 4 randomized trials that compared percutaneous intervention (PCI; n = 2197) and coronary artery bypass grafting (CABG; n = 2197) in adults with left main coronary artery disease and reported 5-year mortality outcomes. The authors were able to obtain the data on the individual participants in these trials. Three of the trials recruited only persons with left main disease. Although the fourth trial included persons with multivessel disease, the authors were able to isolate the subgroups with left main disease. After 5 years, there was no significant difference in all-cause mortality between the 2 groups (slightly > 10%), and no significant difference in cardiovascular and noncardiovascular death. Additionally, the authors found no significant difference in 10-year mortality (slightly > 20%). However, the PCI-managed patients had slightly more spontaneous myocardial infarctions (6.2% vs 2.6%; number needed to treat to harm [NNTH] 31; 95% CI 23 - 47) and subsequent revascularizations (18.3% vs 10.7%; NNTH 14; 11 - 19).