title: Left main coronary artery stenosis: a meta-analysis of drug-eluting stents versus coronary artery bypass grafting.
abstract: OBJECTIVE
  The goal of this study was to provide a systematic review comparing the long-term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (UPLM) stenosis.
  
  
  BACKGROUND
  One-year outcomes from randomized controlled trials, observational studies, and pooled analyses have demonstrated the safety and efficacy of PCI of the UPLM when compared with CABG. However, there remain concerns over the sustainability of PCI with DES at longer follow-up.
  
  
  METHODS
  Studies published between January 2000 and December 2012 of PCI versus CABG for UPLM stenosis were identified using an electronic search and reviewed using meta-analytical techniques.
  
  
  RESULTS
  Twenty-four studies comprising 14,203 patients were included in the analysis. There was no significant difference for all-cause mortality between PCI or CABG at 1 year (odds ratio [OR]: 0.792, 95% confidence interval [CI]: 0.53 to 1.19), 2 years (OR: 0.920, 95% CI: 0.67 to 1.26), 3 years (OR: 0.94, 95% CI: 0.60 to 1.48), 4 years (OR: 0.84, 95% CI: 0.53 to 1.33), and 5 years (OR: 0.79, 95% CI: 0.57 to 1.08). The need for target vessel revascularization (TVR) was significantly higher in patients undergoing PCI at all time points. The occurrence of stroke, however, was significantly less frequent in patients treated with PCI. The occurrence of nonfatal myocardial infarction showed a statistically significant trend towards a lower incidence in CABG patients at 1 year (OR: 1.62, 95% CI: 1.05 to 2.50), 2 years (OR: 1.60, 95% CI: 1.09 to 2.35), and 3 years (OR: 2.06, 95% CI: 1.36 to 3.1). There was no significant difference in combined major adverse cardiovascular and cerebrovascular events between the 2 groups.
  
  
  CONCLUSIONS
  Our findings suggest that PCI with DES is a safe and durable alternative to CABG for the revascularization of UPLM stenosis in select patients at long-term follow-up.
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Athappan
authors.affiliation: Department of Cardiovascular Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Eshan
authors.initials: E
authors.lastname: Patvardhan
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Murat E
authors.initials: ME
authors.lastname: Tuzcu
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Stephen
authors.initials: S
authors.lastname: Ellis
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Patrick
authors.initials: P
authors.lastname: Whitlow
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: kapadis@ccf.org.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D002561:Cerebrovascular Disorders / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: CABG; CI; DES; IVUS; MACCE; MI; OR; PCI; PCI with DES; RCT; SYNTAX score; TVR; UPLM; UPLMS; confidence interval; coronary artery bypass graft surgery; drug-eluting stent(s); intravascular ultrasound; long-term follow-up; major adverse cardiovascular and cerebrovascular event(s); myocardial infarction; odds ratio; percutaneous coronary intervention; randomized controlled trial; target vessel revascularization; unprotected left main coronary artery; unprotected left main coronary artery stenosis