title: Meta-analysis of randomized controlled trials on the treatment of unprotected left main coronary artery disease: one-year outcomes with coronary artery bypass grafting versus percutaneous coronary artery intervention with drug-eluting stent.
abstract: OBJECTIVE
  Coronary artery bypass surgery (CABG) is the standard treatment for left main coronary artery (LMCA) disease. However, percutaneous coronary intervention using drug-eluting stents (DES-PCI) is now widely used and is associated with improved outcomes following coronary revascularization. The goal of this study was to assess early outcomes associated with CABG and DES-PCI among patients with LMCA disease through a meta-analysis of randomized controlled trials.
  
  
  RESULTS
  After searching of electronic databases, three randomized controlled trials with 2601 patients were identified. All-cause death occurred in 3.3% with CABG and 3.6% with DES-PCI (odds ratio [OR], 0.92; 95% confidence interval [CI]= 0.60 to 1.40; p = 0.76). The incidence of myocardial infarction was 2.6% with CABG and 3.8% with DES-PCI (OR, 0.67; 95% CI = 0.43 to 1.05; p = 0.10). Target vessel revascularization occurred in 5.1% with CABG and 11.7% with DES-PCI (OR, 0.40; 95% CI = 0.29 to 0.55; p < 0.0001). Major adverse cardiac and cerebrovascular events (MACCE) occurred in 10.7% with CABG and 15.7% with DES-PCI (OR, 0.40; 95% CI = 0.29 to 0.55; p < 0.0001).
  
  
  CONCLUSIONS
  DES-PCI is a safe alternative to CABG for the management of LMCA disease. However, CABG was superior to DES-PCI in terms of MACCE and need for target vessel revascularization at one year. Thus, CABG remains the standard of care for the treatment of LMCA disease.
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Kajimoto
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.forename: Taira
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Amano
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome