title: A collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease.
abstract: BACKGROUND
  Cardiac surgery is the standard treatment for unprotected left main disease (ULM). Drug-eluting stent (DES) implantation has been recently reported in patients with ULM but with unclear results. We systematically reviewed outcomes of percutaneous DES implantation in ULM.
  
  
  METHODS
  Several databases were searched for clinical studies reporting on > or = 20 patients and > or = 6-month follow-up. The primary end point was major adverse cardiovascular events (MACEs; ie, death, myocardial infarction, or target vessel revascularization [TVR]) at the longest follow-up. Incidence and adjusted risk estimates were pooled with generic inverse variance random-effect methods (95% CIs).
  
  
  RESULTS
  From 823 initial citations, 16 studies were included (1278 patients, median follow-up 10 months). Eight were uncontrolled registries, 5 nonrandomized comparisons between DES and bare-metal stents and 3 nonrandomized comparisons between DES and CABG, with no properly randomized trial. Meta-analysis for DES-based PCI showed, at the longest follow-up, rates of 16.5% (11.7%-21.3%) MACE, 5.5% (3.4%-7.7%) death, and 6.5% (3.7%-9.2%) TVR. Comparison of DES versus bare-metal stent disclosed adjusted odds ratios for MACE of 0.34 (0.16-0.71), and DES versus CABG showed adjusted odds ratios for MACE plus stroke of 0.46 (0.24-0.90). Meta-regression showed that disease location predicted MACE (P = .001) and TVR (P = .020), whereas high-risk features predicted death (P = .027).
  
  
  CONCLUSIONS
  Clinical studies report apparently favorable early and midterm results in selected patients with ULM. However, given their limitations in validity and the inherent risk for DES thrombosis, results from randomized trials are still needed to definitely establish the role of DES implantation instead of the reference treatment, surgery.
authors.affiliation: Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy. gbiondizoccai@gmail.com
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Marzia
authors.initials: M
authors.lastname: Lotrionte
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Price
authors.forename: Paul S
authors.initials: PS
authors.lastname: Teirstein
authors.forename: Evald H
authors.initials: EH
authors.lastname: Christiansen
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.forename: Julian P G
authors.initials: JP
authors.lastname: Gunn
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Antonio
authors.initials: A
authors.lastname: Laudito
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Trevi
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy