Percutaneous Coronary Intervention vs Coronary Artery Bypass Graft Surgery for Left Main Disease in Patients With and Without Acute Coronary Syndromes: A Pooled Analysis of 4 Randomized Clinical Trials
Authors' conclusion
Among largely stable patients undergoing left main revascularization and with predominantly low to intermediate coronary anatomical complexity, those with ACS had higher rates of early death. Nonetheless, rates of all-cause mortality through 5 years were similar with PCI vs CABG in this high-risk subgroup. The relative advantages and disadvantages of PCI vs CABG in terms of early stroke and long-term spontaneous MI and repeat revascularization were consistent regardless of ACS status.
Study context
- Population
- Patients with left main disease equally suitable for PCI or CABG, categorised as presenting with or without ACS; enrolled 2004–20151,466 (33%) with ACS
- Participants
- 4,394 patients
- Comparison
- PCI with drug-eluting stents vs CABG, in patients with vs without ACS
- Outcome
- Death
- Follow-up
- 5 years
Methodological detailsinteraction tested
- Interaction tested
Pooled result
As reported in the abstract
All-cause mortality, by ACS status (subgroups)
PCI vs CABGHazard ratio (95% CI)
ACS: 10.9% vs 11.5%
0.93(0.68–1.27)
No ACS: 11.3% vs 9.6%
1.19(0.95–1.50)
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause death, ACS vs no ACS · 30 days | 3.40 (1.81–6.37) | P < 0.001 | |
| CV death, ACS vs no ACS · 30 days | 3.21 (1.69–6.08) | P < 0.001 | |
| Spontaneous MI, ACS vs no ACS · 5 years | 1.70 (1.25–2.31) | P < 0.001 | |
| Early stroke, by ACS statusPCI vs CABG · ACS | 0.39 (0.12–1.25) | ||
| Early stroke, by ACS statusPCI vs CABG · no ACS | 0.35 (0.16–0.75) | ||
| Spontaneous MI, by ACS status · 5 yearsPCI vs CABG · ACS | 1.74 (1.09–2.77) | ||
| Spontaneous MI, by ACS status · 5 yearsPCI vs CABG · no ACS | 3.03 (1.94–4.72) | ||
| Repeat revascularization, by ACS status · 5 yearsPCI vs CABG · ACS | 1.57 (1.19–2.09) | ||
| Repeat revascularization, by ACS status · 5 yearsPCI vs CABG · no ACS | 1.90 (1.54–2.33) | ||
| 0.10.31310Hazard ratio (log scale) |
Original publication
Percutaneous Coronary Intervention vs Coronary Artery Bypass Graft Surgery for Left Main Disease in Patients With and Without Acute Coronary Syndromes: A Pooled Analysis of 4 Randomized Clinical Trials. JAMA Cardiol. Published 1 July 2023. doi:10.
Summarised from the published abstract; every number is checked against it