title: Drug-eluting stents or coronary artery bypass grafting for unprotected left main coronary artery disease: a meta-analysis of four randomized trials and seventeen observational studies.
abstract: BACKGROUND
  The clinical application of drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) is still controversial. The purpose of this meta-analysis was to compare the safety and efficacy between DES and CABG for ULMCAD.
  
  
  METHODS
  Databases of MEDLINE, EMBASE and the Cochrane Library were systematically searched.
  
  
  RESULTS
  Twenty-one studies with 8,413 patients were included in this meta-analysis. The risk was lower in DES than in CABG groups at the early outcomes of death (risk ratio (RR): 0.49, 95% confidence interval (CI): 0.30-0.78), cerebrovascular events (RR: 0.19, 95% CI: 0.08-0.45) and composite endpoint (RR: 0.53, 95% CI: 0.40-0.70); death after 2 years (RR: 0.81, 95% CI: 0.66-0.99), 4 years (RR: 0.69, 95% CI: 0.53-0.90), 5 years (OR: 0.76, 95% CI: 0.61-0.95) and their total effect (RR: 0.79, 95% CI: 0.71-0.87); composite endpoint 1 year (RR: 0.69, 95% CI: 0.58-0.83), 4 years (RR: 0.69, 95% CI: 0.53-0.88), 5 years (RR: 0.74, 95% CI: 0.59-0.92) and their total effect (RR: 0.78, 95% CI: 0.71-0.85). There were no significant differences in the risk for the early outcomes of myocardial infarction (RR: 0.97, 95% CI: 0.68-1.38), death 1 year (OR: 0.81, 95% CI: 0.57-1.15) and 3 years (OR: 0.85, 95% CI: 0.69-1.04), composite endpoint of 2 years (RR: 0.88, 95% CI: 0.72-1.09) and 3 years (RR: 0.87, 95% CI: 0.73-1.04). Nonetheless, there was a lower risk for revascularization associated with CABG from 1 to 5 years and their total effect (RR: 3.77, 95% CI: 3.35-4.26). There was no difference in death, myocardial infarction, cerebrovascular events or revascularization at 1 year between RCT and observational groups.
  
  
  CONCLUSIONS
  Our meta-analysis indicates that DES has higher safety but higher revascularization than CABG in patients with ULMCAD in the 5 years after intervention.
authors.affiliation: Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021 Guangxi, People's Republic of China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Li
authors.forename: Zhi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Rui-Xing
authors.initials: RX
authors.lastname: Yin
mesh_terms: D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome