[Meta-analysis of long-term outcomes of percutaneous coronary intervention or coronary artery bypass graft surgery in coronary artery disease patients with multi-vessel and/or left main stem disease].
OBJECTIVE
To evaluate the long-term outcomes of coronary artery disease patients with left main stem and/or multi-vessel disease receiving percutaneous coronary intervention (PCI) or coronary artery bypass graft(CABG).


METHODS
PubMed, EMBase, Cochrane central register of controlled trials were searched to identify randomized controlled trials concerning the long-term outcomes of PCI and CABG in coronary artery disease patients with left main stem and/or multi-vessel disease before May 2013.Keywords included "angioplasty", "coronary", "coronary artery bypass surgery" and "stent". The data were analyzed by STATA 12.0.


RESULTS
Six randomized controlled trials (5 071 patients) were enrolled for analyses.Five years all-cause mortality (RR = 1.13, 95% CI: 0.88-1.44, P = 0.35), incidence of myocardial infarction (RR = 1.20, 95% CI: 0.69-2.07, P = 0.53), and angina (RR = 1.17, 95% CI: 0.88-1.57, P = 0.28) were similar between PCI and CABG groups. Major adverse cardiac and cerebrovascular event (RR = 1.85, 95% CI: 1.38-2.48, P < 0.01) and repeat revascularization (RR = 3.48, 95% CI: 2.20-5.53, P < 0.01) were significantly higher in PCI compared to CABG.


CONCLUSIONS
The present analysis suggests that 5 years all-cause mortality is similar between PCI and CABG strategies.However, PCI is associated with higher major adverse cardiac and cerebrovascular event and repeat revascularization rate compared to CABG in patients with unprotected left main stem and/or multi-vessel disease.
Department of Integrated ICU, First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052, China.
Tongwen
T
Sun
Youdong
Y
Wan
Ziqi
Z
Liu
Shuguang
S
Zhang
Fangxia
F
Guan
Rui
R
Yao
Li
L
Zhang
Ling
L
Li
Jinying
J
Zhang
Email: suntongwen@163.com.
Quancheng
Q
Kan
D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction; D062645:Percutaneous Coronary Intervention; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D016896:Treatment Outcome