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Previous meta–analyses of percutaneous coronary intervention (PCI) with drug–eluting stent (DES) versus coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) have abstracted (and then combined) unadjusted risk estimates from not only a few randomized controlled trials (RCTs) but also a number of observational comparative studies (OCSs). Unadjusted risk estimates in OCSs, however, must be highly biased.
Extracting not unadjusted but adjusted risk estimates from OCSs, we performed an updated meta–analysis of DES versus CABG for prevention of late death and major adverse cardiac and cerebral event (MACCE; composite of death, myocardial infarction and stroke) in ULMCAD. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through October 2012. Eligible studies were RCTs or OCSs of DES versus CABG enrolling individuals with ULMCAD and reporting risk estimates (adjusted hazard ratios [HRs] in case of OCSs) for late (≥6–month) death or MACCE as outcomes.
Three RCTs and 19 OCSs enrolling 9,217 patients with ULMCAD were identified. Pooled analysis suggested no significant difference in risk of death (HR, 1.01; 95% confidence interval [CI], 0.86 to 1.18; Fig.) and MACCE (HR, 0.98; 95% CI, 0.86 to 1.13) among patients assigned to DES versus CABG.
With respect to late death and MACCE (not including target vessel revascularization), PCI with DES appears to be compatible with CABG for ULMCAD.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Left Main and Bifurcation Intervention
Abstract Category: 46. TCT@ACC–i2: Coronary Intervention, LM/Bifurcations
Presentation Number: 2105M–243
- 2013 American College of Cardiology Foundation