CABG vs PTCA using drug eluting stents for the treatment of left main coronary artery disease

CABG (surgical procedure) vs PTCA
DRUG ELUTING STENTS FOR THE
TREATMENT OF LEFT MAIN
CORONARY ARTERY DISEASE

Table of Contents
LIST OF FIGURE AND TABLES..................................................................................................1
LIST OF ABBREVIATIONS..........................................................................................................2
ACKNOWLEDGEMENT...............................................................................................................3
ABSTRACT.....................................................................................................................................4
Background.............................................................................................................................4
Methods..................................................................................................................................4
Results....................................................................................................................................4
Conclusion..............................................................................................................................4
TITLE..............................................................................................................................................5
INTRODUCTION...........................................................................................................................5
What is left main coronary artery disease?.............................................................................5
Why left main coronary artery disease is researched?...........................................................5
Causes of left main coronary artery disease...........................................................................6
CABG for the treatment of left main coronary artery disease................................................7
PTCA drug eluting stents for treatment of left main coronary artery disease........................7
Aim.........................................................................................................................................7
Objective.................................................................................................................................8
Research questions.................................................................................................................8
Alternative hypothesis............................................................................................................8
Null hypothesis.......................................................................................................................8
METHODOLOGY..........................................................................................................................9
Criteria for eligibility..............................................................................................................9
Screening of studies..............................................................................................................13
Quality assessment along with data extraction.....................................................................14
Heterogeneity.......................................................................................................................17
Statistics................................................................................................................................17
RESULTS......................................................................................................................................20
PRISMA flowchart...............................................................................................................20
Quality assessment...............................................................................................................22

Data extraction table.............................................................................................................25
DISCUSSION................................................................................................................................29
Risk of bias: ethics................................................................................................................29
Summary of finding..............................................................................................................29
Raw data...............................................................................................................................31
Similar studies......................................................................................................................31
Follow up period...................................................................................................................32
Method based on follow up..................................................................................................33
Limitation.............................................................................................................................34
Future research implication..................................................................................................34
CONCLUSION..............................................................................................................................35
REFERENCES..............................................................................................................................37
APPENDICS..................................................................................................................................41
APPENDIX A: MeSH term..................................................................................................41
APPENDIX B: Data extraction process...............................................................................41

LIST OF FIGURE AND TABLES
Table 1 Eligibility criteria
Table 2 PICO search term which are used to search on
PubMed, EMBASE along with Cochran.
Table 3 Inclusion along with exclusion key terms
which are associated with Covidence
Table 4 Data extraction process of included studies
Table 5 Analysis and comparison between CABG and
PTCA drug eluting method used in treatment
of left main coronary artery disease in given
studies
Table 6 Data extraction table
Figure 1 CABG versus PTCA.
Chart 1 PRISMA flowchart
Chart 2 CABG VS PTCA
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LIST OF ABBREVIATIONS
CABG Coronary artery bypass graft.
PTCA Percutaneous transluminal coronary
angioplasty.
AF Atrial fibrillation.
LMCAD Left main coronary artery disease
RCT Randomised controlled trial
LDL Low density lipoprotein.
HDL High density lipoprotein
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ACKNOWLEDGEMENT
I would like to express my special thank of gratitude to my teacher.......... who gave may a
golden opportunity to do such wonderful project that support my academic journey. The project
is comparative study between CABG and PTCA drug eluting stent in term of effectiveness
for treatment of left main coronary artery disease. I came to know about new thing I really
thankful to them. Apart for this, I would also like to thank my parents and friends who help me to
finalise the project within the limited and proper timeline or timeframe.
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ABSTRACT
Background
The safety and effectiveness of percutaneous coronary intervention along with drug
eluting stent is high debated upon comparison to CABG (coronary artery graft surgery) for a long
period of time.
Methods
Evidence based studies were chosen by surfing PubMed, Cochrane Library and
EMBASE for up to 16th July, 2022. Primarily observed endpoint was myocardial infarction and
stroke during the follow up procedures. Some of the secondary outcomes observed were death,
cardiac death and repeated vascularization.
Results
Four randomized controlled trails and twelve observational studies including 100 patients
per trail. In context with the primary end point, comparing DES and CABG, the confidence
interval or CI was found to be 95%. The incidence of Myocardial infraction was found to be
higher in DES as compared to CABG.
Conclusion
Although it is not cost effective, CABG appears to be safer than PCI with DES for
treatment of left main coronary artery disease for long term follow up. A significant damage is
associated to the artery where stents are inserted in the form of an allergic reaction or direct
damage to the heart. Also, there is a high risk of adverse effects during angioplasty followed by
stent placement along with cognitive impairment including loss of memory and thinking skills.
On the other hand, CABG is associated with lower death rate and less requirement for blood
transfusion.
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TITLE
CABG vs PTCA using drug eluting stents for the treatment of left main coronary artery disease.
INTRODUCTION
What is left main coronary artery disease?
LMCA or left main coronary artery disease is the highest form of lesion which occurs as a
result of ischaemic heart disease. This disease is associated with narrowing of the vessel of the
artery by 50%. Some of the symptoms of LMCAD are heaviness, chest tightness, persistent pain
in heart spreading to arms, legs etc. The left main coronary artery transports blood to the left part
of cardiac muscles. The LMCA further divides into two main branches- The left anterior
descending artery (supplying blood to front-left side of the heart) and The circumflex artery
(transporting blood to the lateral and back side of the heart). There is significant study which is
taken in order to determine the prevalence of unprotected left main coronary artery that is also
known as ULMCA disease which is showing their presence of 5 to 7 percent that is undergoing
within coronary angiography. The left main coronary artery disease is related with heart disease
in simple term the blockage of artery is analysed due to the blood clot. In this, blood clotting is
major issue that is evaluated under the coronary disease especially left main coronary artery
disease. Therefore, left main coronary artery supplies to the left side of heart muscle (the left
auricle and left ventricle). The left main coronary artery is categories into the two branches. The
left anterior descending artery branches off left coronary artery and supplies the blood to front of
the left side of the heart. In this disease the left artery is blocked and inhibit the flow of blood
from one region to another (Bhatt, 2018).
Why left main coronary artery disease is researched?
The left main coronary artery is well discussed above that show clear indication where
appropriate information is evaluated that state the blood clot is major reason that affect the blood
flow or inhibit the blood flow that create complication with patient. The left coronary artery
crucial to be researched as LMCA carries blood to the left atrium and the left ventricle of the
heart. The left side of the heart receives oxygenated blood from the lungs from where the blood
is transported to the rest of the body. If the LMCA is blocked, the supply of blood to the whole
body will be restricted. Therefore, in order to treat this conditions, medical professionals suggest
undergoing coronary artery bypass graft (CABG) for removing blockage and restoration of blood
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