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Vol. 77. Issue 5.
Pages 383-392 (May 2024)
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Vol. 77. Issue 5.
Pages 383-392 (May 2024)
Original article
Results beyond 5-years of surgery or percutaneous approach in severe coronary disease. Reconstructed time-to-event meta-analysis of randomized trials
Resultados tras 5 años de cirugía o abordaje percutáneo en coronariopatía grave. Metanálisis de ensayos aleatorizados con reconstrucción del tiempo hasta el evento
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Francesco Formicaa,,
Corresponding author
, Daniel Hernandez-Vaquerob,, Domenico Tuttolomondoc, Alan Gallinganid, Gurmeet Singhe, Claudia Pattuzzia,d, Giampaolo Niccolia,c, Roberto Lorussof,g, Francesco Nicolinia,d
a Department of Medicine and Surgery, University of Parma, Parma, Italy
b Cardiac Surgery Department, Hospital Universitario Central de Asturias, Oviedo, Spain
c Cardiology Unit, University Hospital of Parma, Parma, Italy
d Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
e Department of Critical Care Medicine and Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
f Cardio-Thoracic Department, Maastricht University Medical Centre, Heart and Vascular Centre, Maastricht, The Netherlands
g Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Roberto Elosua
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Table 1. Baseline variables of enrolled patients
Table 2. Baseline characteristics of trials included in the meta-analysis
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Abstract
Introduction and objectives

There is controversy about the optimal revascularization strategy in severe coronary artery disease (CAD), including left main disease and/or multivessel disease. Several meta-analyses have analyzed the results at 5-year follow-up but there are no results after the fifth year. We conducted a systematic review and meta-analysis of randomized clinical trials, comparing results after the fifth year, between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) using drug-eluting stents in patients with severe CAD.

Methods

We analyzed all clinical trials between January 2010 and January 2023. The primary endpoint was all-cause mortality. The databases of the original articles were reconstructed from Kaplan-Meier curves, simulating an individual-level meta-analysis. Comparisons were made at certain cutoff points (5 and 10 years). The 10-year restricted median survival time difference between CABG and PCI was calculated. The random effects model and the DerSimonian-Laird method were applied.

Results

The meta-analysis included 5180 patients. During the 10-year follow-up, PCI showed a higher overall incidence of all-cause mortality (HR, 1.19; 95%CI, 1.04-1.32; P=.008)]. PCI showed an increased risk of all-cause mortality within 5 years (HR, 1.2; 95%CI, 1.06-1.53; P=.008), while no differences in the 5–10-year period were revealed (HR, 1.03; 95%CI, 0.84-1.26; P=.76). Life expectancy of CABG patients was slightly higher than that of PCI patients (2.4 months more).

Conclusions

In patients with severe CAD, including left main disease and/or multivessel disease, there was higher a incidence of all-cause mortality after PCI compared with CABG at 10 years of follow-up. Specifically, PCI has higher mortality during the first 5 years and comparable risk beyond 5 years.

Keywords:
Coronary artery bypass grafting
Percutaneous coronary intervention
Drug-eluting stent
Meta-analysis
Long-term follow-up
Abbreviations:
CABG
CAD
DES
PCI
RMST
Resumen
Introducción y objetivos

Existe controversia sobre la mejor estrategia de revascularización en la enfermedad coronaria avanzada, incluidas la enfermedad del tronco coronario y la enfermedad multivaso. Varios metanálisis han comparado resultados a 5 años, pero no hay resultados después del quinto año. Se realizaron una revisión sistemática y un metanálisis de ensayos clínicos aleatorizados para comparar los resultados después del quinto año entre la cirugía de revascularización coronaria (CABG) y la intervención coronaria percutánea (ICP) con stents farmacoactivos.

Métodos

Se analizaron los ensayos clínicos publicados entre 2010 y 2023. El objetivo primario fue la mortalidad por cualquier causa. Las bases de datos originales se reconstruyeron a partir de las curvas de Kaplan-Meier simulando un metanálisis individual. Se realizaron comparaciones en ciertos puntos de corte (5 y 10 años). Se calculó la diferencia del tiempo medio de supervivencia restringida. Se aplicó el modelo de efectos aleatorios y de DerSimonian-Laird.

Resultados

Se analizó a 5.180 pacientes. Durante los 10 años de seguimiento, las ICP muestran una mayor incidencia de mortalidad (HR=1,19; IC95%, 1,04-1,32; p=0,008). La ICP muestra un mayor riesgo de mortalidad a 5 años (HR=1,2; IC95%, 1,06-1,53; p=0,008), mientras que no hubo diferencias de 5 a 10 años (HR=1,03; IC95%, 0,84-1,26; p=0,76). La esperanza de vida de los pacientes sometidos a CABG fue ligeramente mayor (2,4 meses más).

Conclusiones

Entre los pacientes con enfermedad coronaria avanzada, incluidas la enfermedad del tronco coronario y la enfermedad multivaso, hubo mayor mortalidad tras una ICP que tras la CABG a los 10 años de seguimiento. En concreto, la ICP tiene mayor mortalidad durante los primeros 5 años y un riesgo comparable de 5 a 10 años.

Palabras clave:
Cirugía de revascularización coronaria
Intervención coronaria percutánea
Stent farmacoactivo
Metanálisis
Seguimiento

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