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ASSA13-15-7 Drug-Eluting Stenting Versus Coronary Artery Bypass Graft For Unprotected Left Main Coronary Artery Disease: A Meta-Analysis Based on Time-To-Event Data from Randomised Controlled Trials

Objective Drug eluting stent (DES) with percutaneous coronary intervention is increasingly used to treat unprotected left main coronary artery (LMCA) disease. We undertook a meta analysis to assess outcomes for coronary artery bypass graft (CABG) and DES for unprotected LMCA disease. Methods We conducted a PubMed/EMBASE/CENTRAL search for RCTs evaluating CABG versus DES for unprotected LMCA. Primary outcome was survival. Secondary outcomes were major adverse cardiac and cerebrovascular event (MACCE) and target vessel revascularization (TVR). Results Four randomised controlled trials were identified evaluating a total of 2, 706 patients with unprotected LMCA. There was no significant difference between the CABG and DES groups in the risk for mortality (HR [hazard ratio]:0.76; 95% CI [confidence interval]: 0.47–1.23). The risks were lower for MACCE (0.78 [95% CI: 0.60–1.02]) and for TVR (0.73 [95% CI: 0.61–0.87]). Conclusions our meta-analysis of RCTs suggests that there are no significant differences in terms of survival and MACCE in patients with unprotected LMCA disease suitable for either DES or CABG, but CABG is superior to DES in reducing the incidence of TVR.