title: Percutaneous coronary intervention or coronary artery bypass grafting for unprotected left main coronary artery disease.
abstract: BACKGROUND
  Recent trials comparing PCI with CABG for unprotected left main disease yielded discrepant evidence.
  
  
  OBJECTIVE
  To perform an updated meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease.
  
  
  METHODS
  Randomized trials comparing PCI versus CABG for patients with unprotected left main coronary artery disease were included. Summary estimates risk ratios (RRs) were performed with a DerSimonian and Laird model at short-term, intermediate and long-term follow-up periods (i.e., 30-days, 1-year, and >1-year). Outcomes evaluated were major adverse cardiac and cerebrovascular events (MACCE), all-cause mortality, myocardial infarction, stroke, revascularization and stent thrombosis or symptomatic graft occlusion.
  
  
  RESULTS
  Six trials with 4,700 patients and a mean SYNTAX score of 23 were included. At short-term follow-up, the risk of MACCE was lower with PCI (RR 0.55, 95% confidence interval [CI] 0.39-0.76) driven by the lower risk of myocardial infarction (RR 0.67, 95% CI 0.46-0.99), and stroke (RR 0.38, 95% CI 0.16-0.90). The risk of MACCE was similar at the intermediate follow-up (RR 1.21, 95% CI 0.97-1.51). At long-term follow-up, PCI was associated with a higher risk of MACCE (RR 1.19, 95% CI 1.01-1.41), due to a higher risk of revascularization (RR 1.62, 95% CI 1.34-1.94), while the risk of all-cause mortality, myocardial infarction, and stroke were similar.
  
  
  CONCLUSIONS
  In patients with unprotected left main coronary disease and low to intermediate SYNTAX score, PCI might be an acceptable alternative to CABG. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Mahmoud
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
authors.forename: Islam Y
authors.identifier: http://orcid.org/0000-0001-9853-7591
authors.initials: IY
authors.lastname: Elgendy
authors.affiliation: Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa.
authors.forename: Amgad
authors.initials: A
authors.lastname: Mentias
authors.affiliation: Division of Cardiovascular Medicine, University of Arkansas, Little Rock, Arkansas.
authors.forename: Marwan
authors.identifier: http://orcid.org/0000-0002-2280-8030
authors.initials: M
authors.lastname: Saad
authors.affiliation: Department of Medicine, Wayne State University, Detroit, Michigan.
authors.forename: Walid
authors.initials: W
authors.lastname: Ibrahim
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Mojadidi
authors.affiliation: Division of Cardiovascular Medicine, University of Arkansas, Little Rock, Arkansas.
authors.forename: Ramez
authors.initials: R
authors.lastname: Nairooz
authors.affiliation: Division of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Parham
authors.initials: P
authors.lastname: Eshtehardi
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
authors.forename: R
authors.initials: R
authors.lastname: David Anderson
authors.affiliation: Division of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Habib
authors.initials: H
authors.lastname: Samady
mesh_terms: D000368:Aged; D000066491:Clinical Decision-Making; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery bypass grafting; coronary artery disease; mortality; percutaneous coronary intervention; stroke