Abstract 12764: Comparison between Drug-Eluting Stents and Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease: A Pooled Analysis of Three Randomized Trials and Six Observational Studies
Background: The clinical outcomes for unprotected left main coronary artery (ULMCA) disease between coronary artery bypass grafting (CABG) and drug-eluting stents (DES) remain controversial. The objective of this study was to compare the safety and efficacy of percutaneous coronary intervention (PCI) using DES with CABG in patients with ULMCA disease.
Methods: Databases were searched for clinical studies that reported outcomes after PCI with DES and CABG for the treatment of ULMCA disease. The end points of this meta-analysis were mortality; the composite of death, myocardial infarction, or stroke; and target vessel revascularization at 1-year follow-up. The pooled effects were calculated using fixed-effects model (Mantel-Haenszel method) or random effects models (Dersimonian and Laird method).
Results: Nine clinical studies (3 randomized trials and 6 observational studies) with 4,989 patients were involved in this study. At 1-year follow-up, there was no significant difference between the DES and CABG groups in the risk for death (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.49 to 1.23, p=0.29) or the composite end point of death, myocardial infarction, or stroke (OR 0.79, 95% CI 0.62 to 1.02, p=0.07). Target vessel revascularization was significantly higher in the DES group compared to the CABG group (OR 3.01, 95% CI 2.33 to 3.88, p<0.001).
Conclusions: Our meta-analysis indicates that there are no significant differences in the safety between DES and CABG for the treatment of ULMCA disease. In selected cases with ULMCA disease, PCI with DES is emerging as a good alternative.
- © 2011 by American Heart Association, Inc.