title: Percutaneous coronary intervention versus bypass surgery for left main coronary artery disease: a meta-analysis of randomised trials.
abstract: OBJECTIVE
  We performed a meta-analysis of randomised trials comparing percutaneous coronary intervention (PCI) with stent implantation to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis (ULMCA).
  
  
  RESULTS
  Pubmed and other databases were searched. Data were expressed as odds ratios (OR) with 95% confidence interval (CI). Four randomised trials enrolling 1,611 patients were selected. At 12-month follow-up PCI, as compared to CABG, was associated with a significant risk reduction of stroke (0.12% vs. 1.90%, OR 0.14, 95% CI [0.04 to 0.55], p=0.004), with an increased risk of repeat revascularisation (11.03% vs. 5.45%, OR 2.17, 95% CI [1.48 to 3.17], p <0.001), a similar risk of mortality (OR 0.72, 95% CI [0.42 to 1.24], p=0.23) or myocardial infarction (OR 0.97, 95% CI [0.54 to 1.74], p=0.91), leading to an increased risk of major adverse cardiovascular events (14.37% vs. 10.14%, OR 1.50, 95% CI [1.10 to 2.04], p=0.01) and similar hazard of major adverse cardiac or cerebrovascular events (14.49% vs. 12.04%, OR 1.24, 95% CI [0.93 to 1.67], p=0.15).
  
  
  CONCLUSIONS
  PCI is comparable to CABG for the treatment of ULMCA with respect to the composite of major adverse cardiovascular or cerebrovascular events at 12-month follow-up.
authors.affiliation: Department of Interventional Cardiology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy. giu.ferrante@hotmail.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Paolo
authors.initials: P
authors.lastname: Pagnotta
authors.forename: Guido
authors.initials: G
authors.lastname: Belli
authors.forename: Elena
authors.initials: E
authors.lastname: Corrada
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Peter
authors.initials: P
authors.lastname: Barlis
authors.forename: Didier
authors.initials: D
authors.lastname: Locca
authors.forename: Eric
authors.initials: E
authors.lastname: Eeckhout
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D023921:Coronary Stenosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D019233:Retreatment; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome