title: Percutaneous coronary intervention versus coronary artery bypass graft surgery in left main coronary artery disease: a meta-analysis of randomized clinical data.
abstract: OBJECTIVE
  The purpose of this study was to determine the safety and efficacy of percutaneous coronary intervention (PCI) compared with coronary artery bypass graft (CABG) in patients with left main coronary artery (LMCA) disease.
  
  
  BACKGROUND
  Previous meta-analyses of PCI versus CABG in LMCA disease mainly included nonprospective, observational studies. Several new randomized trials have recently been reported.
  
  
  METHODS
  We identified 1,611 patients from 4 randomized clinical trials for the present meta-analysis. The primary endpoint was the 1-year incidence of major adverse cardiac and cerebrovascular events (MACCE), defined as death, myocardial infarction (MI), target vessel revascularization (TVR), or stroke.
  
  
  RESULTS
  PCI was associated with a nonsignificantly higher 1-year rate of MACCE compared with CABG (14.5% vs. 11.8%; odds ratio [OR]: 1.28; 95% confidence interval [CI]: 0.95 to 1.72; p = 0.11), driven by increased TVR (11.4% vs. 5.4%; OR: 2.25; 95% CI: 1.54 to 3.29; p < 0.001). Conversely, stroke occurred less frequently with PCI (0.1% vs. 1.7%; OR: 0.15; 95% CI: 0.03 to 0.67; p = 0.013). There were no significant differences in death (3.0% vs. 4.1%; OR: 0.74; 95% CI: 0.43 to 1.29; p = 0.29) or MI (2.8% vs. 2.9%; OR: 0.98; 95% CI: 0.54 to 1.78; p = 0.95).
  
  
  CONCLUSIONS
  In patients with LMCA disease, PCI was associated with nonsignificantly different 1-year rates of MACCE, death, and MI, a lower risk of stroke, and a higher risk of TVR compared with CABG.
authors.affiliation: Ferrarotto Hospital and ETNA Foundation, Catania, Italy. dcapodanno@gmail.com
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Marie C
authors.initials: MC
authors.lastname: Morice
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Bass
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000401:mortality; D016896:Treatment Outcome