According to this new meta-analysis (presented at AHA 2021 and published in The Lancet), mortality is similar between surgery and angioplasty to treat left main coronary artery in patients with simple or intermediate anatomy.
This new study estimates that, after 5 years, mortality with surgery would be 11.2% vs. 10.2% with angioplasty, a non-significant difference.
This debate has been going on for years and finally exploded after publishing the 5-year results from the EXCEL study, where angioplasty showed a lower mortality rate than surgery. Following this publication, the Thoracic Surgery Society withdrew their support to the latest guidelines because a BBC investigation suggested that data were being manipulated. Shortly after, the 5-year follow-up from NOBLE was published, with results favoring surgery.
In this context, this meta-analysis intended to cool down the situation with reliable results, pooling 4394 patients from EXCEL, NOBLE, SYNTAX and PRECOMBAT. All patients had at least 5 years of clinical follow-up.
The absolute risk difference between both revascularization strategies was 0.9% in favor of surgery, but this difference is non-significant.
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The same conclusion was reached based only on SYNTAX and PRECOMBAT (the only studies with at least 10 years of data).
Original Title: Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis.
Reference: Marc S Sabatine et al. Presentado en el congreso AHA 2021 y publicado simultáneamente en Lancet. 2021 Nov 12;S0140-6736(21)02334-5. Online ahead of print. doi: 10.1016/S0140-6736(21)02334-5.
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