Meta-analysis of randomized controlled trials on the treatment of unprotected left main coronary artery disease: one-year outcomes with coronary artery bypass grafting versus percutaneous coronary artery intervention with drug-eluting stent.

BACKGROUND AND AIM: Coronary artery bypass surgery (CABG) is the standard treatment for left main coronary artery (LMCA) disease. However, percutaneous coronary intervention using drug-eluting stents (DES-PCI) is now widely used and is associated with improved outcomes following coronary revascularization. The goal of this study was to assess early outcomes associated with CABG and DES-PCI among patients with LMCA disease through a meta-analysis of randomized controlled trials.

METHODS AND RESULTS: After searching of electronic databases, three randomized controlled trials with 2601 patients were identified. All-cause death occurred in 3.3% with CABG and 3.6% with DES-PCI (odds ratio [OR], 0.92; 95% confidence interval [CI]= 0.60 to 1.40; p = 0.76). The incidence of myocardial infarction was 2.6% with CABG and 3.8% with DES-PCI (OR, 0.67; 95% CI = 0.43 to 1.05; p = 0.10). Target vessel revascularization occurred in 5.1% with CABG and 11.7% with DES-PCI (OR, 0.40; 95% CI = 0.29 to 0.55; p < 0.0001). Major adverse cardiac and cerebrovascular events (MACCE) occurred in 10.7% with CABG and 15.7% with DES-PCI (OR, 0.40; 95% CI = 0.29 to 0.55; p < 0.0001).

CONCLUSIONS: DES-PCI is a safe alternative to CABG for the management of LMCA disease. However, CABG was superior to DES-PCI in terms of MACCE and need for target vessel revascularization at one year. Thus, CABG remains the standard of care for the treatment of LMCA disease.