title: Five-year outcomes following PCI with DES versus CABG for unprotected LM coronary lesions: meta-analysis and meta-regression of 2914 patients.
abstract: OBJECTIVE
  To compare the safety and efficacy at long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease.
  
  
  METHODS
  MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for clinical studies that reported outcomes at 5-year follow-up after PCI with DES and CABG for the treatment of ULMCA stenosis. Five studies (1 randomized controlled trial and 4 observational studies) were identified and included a total of 2914 patients (1300 for CABG and 1614 for PCI with DES).
  
  
  RESULTS
  At 5-year follow-up, there was no significant difference between the CABG and PCI-DES groups in the risk for death (odds ratio [OR] 1.159, P=0.168 for random effect) or the composite endpoint of death, myocardial infarction, or stroke (OR 1.214, P=0.083). The risk for target vessel revascularization (TVR) was significantly lower in the CABG group compared to the PCI-DES group (OR 0.212, P<0.001). The risk of major adverse cardiac and cerebrovascular events (MACCE) was significantly lower in the CABG group compared to the PCI-DES group (OR 0.526, P<0.001). It was observed no publication bias about outcomes and considerably heterogeneity effect about MACCE.
  
  
  CONCLUSIONS
  CABG surgery remains the best option of treatment for patients with ULMCA disease, with less need of TVR and MACCE rates at long-term follow-up.
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco (UPE), Recife, PE, Brazil. michel_pompeu@yahoo.com.br
authors.forename: Michel Pompeu Barros de Oliveira
authors.initials: MP
authors.lastname: Sá
authors.forename: Paulo Ernando
authors.initials: PE
authors.lastname: Ferraz
authors.forename: Rodrigo Renda
authors.initials: RR
authors.lastname: Escobar
authors.forename: Eliobas Oliveira
authors.initials: EO
authors.lastname: Nunes
authors.forename: Alexandre Magno Macário Nunes
authors.initials: AM
authors.lastname: Soares
authors.forename: Frederico Browne Correia de
authors.initials: FB
authors.lastname: Araújo e Sá
authors.forename: Frederico Pires
authors.initials: FP
authors.lastname: Vasconcelos
authors.forename: Ricardo Carvalho
authors.initials: RC
authors.lastname: Lima
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome