title: Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Narrowing.
abstract: Patients with unprotected left main coronary artery (ULMCA) disease are increasingly treated with percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES); however, the benefits of DES compared with coronary artery bypass grafting (CABG) in ULMCA remain controversial. This meta-analysis evaluated the effects of PCI with DES compared with CABG for the treatment of ULMCA stenosis. Databases were searched through November 30, 2016. Randomized controlled trials (RCTs) comparing DES with PCI versus CABG for ULMCA stenosis were identified. We calculated summary odds ratios (ORs) and 95% CIs with the random-effects model. The primary outcome was major adverse cardiovascular events, defined as a composite of death from any cause, stroke, or myocardial infarction (MI). The analysis included 4,612 patients from 5 RCTs. Compared with CABG, patients assigned to PCI had a similar rate of major adverse cardiovascular events (OR 1.06, 95% CI 0.79 to 1.43), all-cause mortality (OR 1.03, 95% CI 0.79 to 1.35), cardiovascular death (OR 1.03, 95% CI 0.73 to 1.45), stroke (OR 0.81, 95% CI 0.38 to 1.76), and MI (OR 1.47, 95% CI 0.87 to 2.47). The risk of any repeat revascularization was significantly greater in the PCI group than that in the CABG group (OR 1.85, 95% CI 1.53 to 2.24). In conclusion, our meta-analysis of RCTs suggest that PCI with DES results in comparable mortality, stroke, and MI compared with CABG for revascularization of ULMCA stenosis, with PCI associated with higher rates of repeat revascularization.
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah. Electronic address: parthasardarmd@gmail.com.
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.affiliation: Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jay
authors.initials: J
authors.lastname: Giri
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sammy
authors.initials: S
authors.lastname: Elmariah
authors.affiliation: Cardiology Division, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Amartya
authors.initials: A
authors.lastname: Kundu
authors.affiliation: Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arizona.
authors.forename: Ramez
authors.initials: R
authors.lastname: Nairooz
authors.affiliation: Division of Cardiovascular Medicine, Westchester Medical Center-New York Medical College, New York, New York.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Theophilus
authors.initials: T
authors.lastname: Owan
authors.affiliation: Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, Texas.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.affiliation: Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D023921:Coronary Stenosis / Q000601:surgery*; D054855:Drug-Eluting Stents; D014943:Global Health; D006801:Humans; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends