title: Drug-eluting stent placement versus coronary artery bypass surgery for unprotected left main coronary artery disease: A meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Coronary artery bypass grafting (CABG) is the standard of care for treating left main coronary lesions. However, recently published randomized controlled trials (RCT) have shown conflicting results. We sought to compare clinical outcomes of percutaneous coronary intervention (PCI) with drug-eluting stent placement to CABG using a meta-analysis of randomized controlled trials.
  
  
  METHODS
  A systemic search of Pubmed, Scopus, Cochrane library, and Clinicaltrials.gov was performed for randomized controlled trials comparing PCI with CABG in patients with left main stenosis. Data were analyzed using random effect models and Mantel-Haenszel methods. The primary outcome was major adverse cardiovascular and cerebral events (MACCE). The secondary outcomes were myocardial infarction, stroke, cardiac, and all-cause mortality. A subgroup analysis based on SYNTAX score was also performed.
  
  
  RESULTS
  A total of 4595 patients (2297 in the PCI group and 2298 in the CABG group) from five RCTs were included in the analysis. There were significant differences in MACCE (odds ratio [OR] 1.36, confidence interval [CI] 95%, 1.18-1.58, p-value: < 0.0001) and repeat revascularization (OR 1.85, CI 95%, 1.53-2.23, p-value: < 0.00001) favoring CABG. There were no significant differences in the incidence of myocardial infarction, stroke, or cardiac and all-cause mortality. Based on SYNTAX score, CABG was superior in terms of MACCE only in the subgroup with SYNTAX score of 33 or more.
  
  
  CONCLUSIONS
  CABG results in fewer MACCE and need for repeat revascularization than PCI in patients with unprotected left main disease.
authors.affiliation: Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan.
authors.forename: Sunil
authors.initials: S
authors.lastname: Upadhaya
authors.affiliation: Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan.
authors.forename: Ramkaji
authors.initials: R
authors.lastname: Baniya
authors.affiliation: Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan.
authors.forename: Seetharamprasad
authors.initials: S
authors.lastname: Madala
authors.affiliation: Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan.
authors.forename: Suresh Kumar
authors.initials: SK
authors.lastname: Subedi
authors.affiliation: Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan.
authors.forename: Jahangir
authors.initials: J
authors.lastname: Khan
authors.affiliation: Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan.
authors.forename: Ravi Kanth
authors.initials: RK
authors.lastname: Velagapudi
authors.affiliation: Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Bachuwa
mesh_terms: D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome