A collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease.
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.
Biondi-Zoccai
Giuseppe G L
GG
Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy. gbiondizoccai@gmail.com
Lotrionte
Marzia
M
Moretti
Claudio
C
Meliga
Emanuele
E
Agostoni
Pierfrancesco
P
Valgimigli
Marco
M
Migliorini
Angela
A
Antoniucci
David
D
Carrié
Didier
D
Sangiorgi
Giuseppe
G
Chieffo
Alaide
A
Colombo
Antonio
A
Price
Matthew J
MJ
Teirstein
Paul S
PS
Christiansen
Evald H
EH
Abbate
Antonio
A
Testa
Luca
L
Gunn
Julian P G
JP
Burzotta
Francesco
F
Laudito
Antonio
A
Trevi
Gian Paolo
GP
Sheiban
Imad
I
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