title: Bypass surgery versus percutaneous coronary intervention for the treatment of unprotected left main disease. A meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  We performed a meta-analysis of randomized controlled trials to compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for the treatment of de novo unprotected left main disease.
  
  
  BACKGROUND
  Although CABG is accepted to be standard of care for revascularization of unprotected left main stenosis, PCI is increasingly being used as an alternative primary approach.
  
  
  METHODS
  We searched for randomized, controlled trials comparing CABG and PCI for the treatment of unprotected left main disease. Major adverse cardiac and cerebrovascular events (all-cause death, myocardial infarction, stroke, and repeat revascularization) were analyzed.
  
  
  RESULTS
  The search strategy identified 4 randomized controlled trials enrolling a total of 1,611 patients. Follow-up ranged between 1 and 2 years. There were no significant differences in the risk of death or myocardial infarction between the two treatment modalities. While the risk of stroke was significantly lower in patients undergoing PCI (risk ratio (RR) 0.26, 95% confidence interval (CI) 0.10-0.69, p = 0.007), the risk of repeat revascularization was higher among patients undergoing PCI (RR 1.94, 95% CI 1.43-2.61, p < 0.001). No relevant statistical heterogeneity across studies could be found.
  
  
  CONCLUSIONS
  In this largest series of randomized patients with unprotected left main stenosis to date, the risk of death and myocardial infarction was comparable between CABG and PCI. However, patients undergoing CABG had a higher risk of stroke, whereas patients undergoing PCI were at a higher risk for repeat revascularization.
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Strümpellstrasse 39, Leipzig, Germany. stdesch@web.de
authors.forename: S
authors.initials: S
authors.lastname: Desch
authors.forename: E
authors.initials: E
authors.lastname: Boudriot
authors.forename: A
authors.initials: A
authors.lastname: Rastan
authors.forename: P E
authors.initials: PE
authors.lastname: Buszman
authors.forename: A
authors.initials: A
authors.lastname: Bochenek
authors.forename: F W
authors.initials: FW
authors.lastname: Mohr
authors.forename: G
authors.initials: G
authors.lastname: Schuler
authors.forename: H
authors.initials: H
authors.lastname: Thiele
mesh_terms: D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome