title: Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  It is not clear whether percutaneous coronary intervention (PCI) is as effective and safe as coronary artery bypass grafting (CABG) for left main coronary artery disease. We aimed to perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that compared PCI and CABG in left main coronary disease.
  
  
  METHODS
  We searched PubMed, EMBASE, Cochrane, Scopus and relevant references for RCTs (inception through, November 20, 2016 without language restrictions) and performed meta-analysis using random-effects model. All-cause mortality, myocardial infarction, revascularization rate, stroke, and major adverse cardiac and cerebrovascular events (MACCE) were the measured outcomes.
  
  
  RESULTS
  Six RCTs with a total population of 4700 were analyzed. There was no difference in all-cause mortality at 30-day, one-year, and five-year (1.8% vs 1.1%; OR 0.60; 95% CI: 0.26-1.39; P=.23; I2=9%) follow-up between PCI and CABG. CABG group had less myocardial infarction (MI) at five-year follow-up than PCI (5% vs 2.5%; OR 2.04; CI: 1.30-3.19; P=.002; I2=1%). Revascularization rate favored CABG in one-year (8.6% vs 4.5%; OR 2; CI: 1.46-2.73; P<.0001; I2=45%) and five-year (15.9% vs 9.9%; OR 1.73; CI: 1.36-2.20; P<.0001; I2=0%) follow-up. Although stroke rate was lower in PCI group at 1 year, there was no difference in longer follow-up. MACCE at 5 years favored CABG (24% vs 18%; OR 1.45; CI: 1.19-1.76; P=.0001; I2=0%). On subgroup analysis, MACCE were not different between two groups in low-to-intermediate SYNTAX group while it was higher for PCI group with high SYNTAX group.
  
  
  CONCLUSIONS
  Percutaneous coronary intervention could be as safe and effective as CABG in a select group of left main coronary artery disease patients.
authors.affiliation: University of New England, LRGHealthcare, Laconia, NH, USA.
authors.forename: Sharan P
authors.identifier: http://orcid.org/0000-0001-5846-4578
authors.initials: SP
authors.lastname: Sharma
authors.affiliation: Division of Cardiology, Louisiana State University Health Science Center, Shreveport, LA, USA.
authors.forename: Khagendra
authors.initials: K
authors.lastname: Dahal
authors.affiliation: University of New England, LRGHealthcare, Laconia, NH, USA.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Khatra
authors.affiliation: Concord Cardiac Associates, Concord, NH, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Rosenfeld
authors.affiliation: Division of Interventional Cardiology, Section of Cardiology, University of Connecticut, Farmington, CT, USA.
authors.forename: Juyong
authors.initials: J
authors.lastname: Lee
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Drug-eluting stent; Left main disease; Percutaneous coronary intervention