Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regression
Background: Previous studies suggest similar cardiovascular (CV) benefits for either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD). However, limited data exist on the influence of prior cerebrovascular disea...
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Elsevier
2025-03-01
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| Series: | International Journal of Cardiology. Cardiovascular Risk and Prevention |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S277248752500008X |
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| author | Muhammad Hamza Shuja Firzah Shakil Syed Hassaan Ali Qazi Shurjeel Uddin Ayesha Noman Javed Iqbal Muhammad Ahmed Faiza Sajid Haya Waseem Ansari Syed Ahmed Farhan Huzaifa Ul Haq Ansari Syed Husain Farhan Muhammad Moiz Nasir Sana Qazi Muhammad Majid |
| author_facet | Muhammad Hamza Shuja Firzah Shakil Syed Hassaan Ali Qazi Shurjeel Uddin Ayesha Noman Javed Iqbal Muhammad Ahmed Faiza Sajid Haya Waseem Ansari Syed Ahmed Farhan Huzaifa Ul Haq Ansari Syed Husain Farhan Muhammad Moiz Nasir Sana Qazi Muhammad Majid |
| author_sort | Muhammad Hamza Shuja |
| collection | DOAJ |
| description | Background: Previous studies suggest similar cardiovascular (CV) benefits for either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD). However, limited data exist on the influence of prior cerebrovascular disease (CEVD). Thus, we aim to compare the CV outcomes in patients with LMCAD and prior CEVD, undergoing either PCI or CABG. Methods: A comprehensive search from (January 2000 to August 2024) identified three relevant studies. Outcomes analyzed included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), and risk of stroke in patients undergoing either PCI or CABG for LMCAD. Data analysis employed a random effects model and presented hazard ratios (HR) along with their 95 % confidence intervals (CI). Results: Three studies involving 760 patients (361 PCI, 399 CABG) were included. PCI was associated with a significantly higher risk of MACCE (HR = 2.56; 95 % CI = 1.23–5.37; p = 0.01; I2 = 86 %) and MI (HR = 2.97; 95 % CI = 1.72–5.13; p < 0.0001; I2 = 0 %) compared to CABG. No significant differences were observed in all-cause mortality (HR = 1.35; 95 % CI = 0.92–1.98; p = 0.12; I2 = 0 %) or recurrent stroke (HR = 0.83; 95 % CI = 0.40–1.70; p = 0.60; I2 = 1 %). The risk of repeat revascularization was higher in PCI, though not statistically significant (HR = 3.44; 95 % CI = 0.50–23.60; p = 0.21; I2 = 70 %). Conclusion: PCI significantly elevates the risk of MACCE and MI in patients with LMCAD and prior CEVD compared to CABG. However, risks of all-cause mortality, repeat stroke, and revascularization were non-significant. Comorbidities may drive the elevated risk, underscoring the need for tailored strategies in this population. |
| format | Article |
| id | doaj-art-ffa35e3ec4584d249ba5a0a2be778709 |
| institution | OA Journals |
| issn | 2772-4875 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology. Cardiovascular Risk and Prevention |
| spelling | doaj-art-ffa35e3ec4584d249ba5a0a2be7787092025-08-20T01:57:19ZengElsevierInternational Journal of Cardiology. Cardiovascular Risk and Prevention2772-48752025-03-012420037010.1016/j.ijcrp.2025.200370Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regressionMuhammad Hamza Shuja0Firzah Shakil1Syed Hassaan Ali2Qazi Shurjeel Uddin3Ayesha Noman4Javed Iqbal5Muhammad Ahmed6Faiza Sajid7Haya Waseem Ansari8Syed Ahmed Farhan9Huzaifa Ul Haq Ansari10Syed Husain Farhan11Muhammad Moiz Nasir12Sana Qazi13Muhammad Majid14Department of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, PakistanNursing Department Communicable Diseases Centre Hamad Medical Corporation, Doha, Qatar; Corresponding author.Department of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Medicine, Liaquat National Hospital and Medical College, PakistanDepartment of Medicine, Liaquat National Hospital and Medical College, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, PakistanDepartment of Internal Medicine, AdventHealth Sebring, Sebring, FL, USABackground: Previous studies suggest similar cardiovascular (CV) benefits for either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD). However, limited data exist on the influence of prior cerebrovascular disease (CEVD). Thus, we aim to compare the CV outcomes in patients with LMCAD and prior CEVD, undergoing either PCI or CABG. Methods: A comprehensive search from (January 2000 to August 2024) identified three relevant studies. Outcomes analyzed included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), and risk of stroke in patients undergoing either PCI or CABG for LMCAD. Data analysis employed a random effects model and presented hazard ratios (HR) along with their 95 % confidence intervals (CI). Results: Three studies involving 760 patients (361 PCI, 399 CABG) were included. PCI was associated with a significantly higher risk of MACCE (HR = 2.56; 95 % CI = 1.23–5.37; p = 0.01; I2 = 86 %) and MI (HR = 2.97; 95 % CI = 1.72–5.13; p < 0.0001; I2 = 0 %) compared to CABG. No significant differences were observed in all-cause mortality (HR = 1.35; 95 % CI = 0.92–1.98; p = 0.12; I2 = 0 %) or recurrent stroke (HR = 0.83; 95 % CI = 0.40–1.70; p = 0.60; I2 = 1 %). The risk of repeat revascularization was higher in PCI, though not statistically significant (HR = 3.44; 95 % CI = 0.50–23.60; p = 0.21; I2 = 70 %). Conclusion: PCI significantly elevates the risk of MACCE and MI in patients with LMCAD and prior CEVD compared to CABG. However, risks of all-cause mortality, repeat stroke, and revascularization were non-significant. Comorbidities may drive the elevated risk, underscoring the need for tailored strategies in this population.http://www.sciencedirect.com/science/article/pii/S277248752500008XPercutaneous coronary interventionCoronary artery bypass graftLeft main coronary artery diseaseCerebrovascular disease |
| spellingShingle | Muhammad Hamza Shuja Firzah Shakil Syed Hassaan Ali Qazi Shurjeel Uddin Ayesha Noman Javed Iqbal Muhammad Ahmed Faiza Sajid Haya Waseem Ansari Syed Ahmed Farhan Huzaifa Ul Haq Ansari Syed Husain Farhan Muhammad Moiz Nasir Sana Qazi Muhammad Majid Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regression International Journal of Cardiology. Cardiovascular Risk and Prevention Percutaneous coronary intervention Coronary artery bypass graft Left main coronary artery disease Cerebrovascular disease |
| title | Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regression |
| title_full | Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regression |
| title_fullStr | Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regression |
| title_full_unstemmed | Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regression |
| title_short | Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regression |
| title_sort | comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease a systematic review meta analysis and meta regression |
| topic | Percutaneous coronary intervention Coronary artery bypass graft Left main coronary artery disease Cerebrovascular disease |
| url | http://www.sciencedirect.com/science/article/pii/S277248752500008X |
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