title: Drug-eluting stents versus coronary artery bypass graft surgery in left main coronary artery disease: a meta-analysis of early outcomes from randomized and nonrandomized studies.
abstract: OBJECTIVE
  The present meta-analysis aimed to compare the short-term safety and efficacy of drug-eluting stents and coronary artery bypass graft surgery for patients with left main coronary artery disease.
  
  
  METHODS
  Fourteen relevant studies were identified from 5 electronic databases. End points included mortality, stroke, myocardial infarction, repeat revascularization, and major adverse cardiac and cerebrovascular events.
  
  
  RESULTS
  Results indicate that all-cause mortality was similar between drug-eluting stents and coronary artery bypass grafting at 30 days and at follow-up beyond 1 year. Likewise, the incidence of myocardial infarction was similar between drug-eluting stents and coronary artery bypass grafting at 12 months and at follow-up beyond 1 year. However, drug-eluting stents were associated with a lower incidence of all-cause mortality at 12 months and a higher incidence of myocardial infarction at 30 days compared with coronary artery bypass grafting. Drug-eluting stents were consistently associated with a higher incidence of repeat revascularization, whereas coronary artery bypass grafting had a higher incidence of stroke. The incidence of major adverse cardiac and cerebrovascular events was similar between the 2 groups at 30 days but higher for drug-eluting stents at 12 months and beyond.
  
  
  CONCLUSIONS
  Patients treated by drug-eluting stents in randomized controlled trials and observational studies in the current literature are often a preselected subgroup with less complex lesions compared with the overall target population. Results drawn from these studies should be viewed with caution. Coronary artery bypass grafting is associated with a lower incidence of major adverse cardiac and cerebrovascular events at 1 year and beyond, and thus should be regarded as the standard of treatment. However, drug-eluting stents may have a role for selected patients with percutaneously amenable left main disease who are poor surgical candidates.
authors.affiliation: The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cao
authors.forename: Con
authors.initials: C
authors.lastname: Manganas
authors.forename: Paul
authors.initials: P
authors.lastname: Bannon
authors.forename: Michael
authors.initials: M
authors.lastname: Vallely
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
mesh_terms: D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D003627:Data Interpretation, Statistical; D054855:Drug-Eluting Stents; D023381:Endpoint Determination; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors