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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

Authors


  • Conflict of interest: None.

  • The abstract was presented at the 59th Annual Scientific Session of the Japanese College of Cardiology held at Kobe International Convention Center, Hyogo, from September 23 to 25, 2011.

Taira Yamamoto, M.D., Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan. Fax: +81-3-3813-3210; e-mail: tyamamo@juntendo.ac.jp

Abstract

Abstract 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.

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