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Drug‐eluting stents versus coronary artery bypass grafting for left‐main coronary artery disease
Author(s) -
Takagi Hisato,
Ando Tomo,
Umemoto Takuya
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27235
Subject(s) - medicine , conventional pci , cardiology , percutaneous coronary intervention , stroke (engine) , myocardial infarction , hazard ratio , coronary artery disease , observational study , revascularization , propensity score matching , confidence interval , mechanical engineering , engineering
Objectives To compare follow‐up outcomes after percutaneous coronary intervention with drug‐eluting stents (DES‐PCI) versus coronary artery bypass grafting (CABG) for left‐main coronary artery disease (LMCAD), we performed a meta‐analysis of randomized controlled trials (RCTs) and observational studies with propensity‐score analysis. Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through November 2016. Eligible studies were RCTs or observational studies with propensity‐score analysis of DES‐PCI versus CABG enrolling patients with LMCAD and reporting ≥ 6‐month mortality, myocardial infarction (MI), stroke, or repeat revascularization (RRV). Study‐specific estimates were combined using inverse variance‐weighted averages of logarithmic hazard ratios (HRs) in the random‐effects model. Results We identified 5 RCTs and 17 observational studies with propensity‐score analysis enrolling a total of 12,387 patients. Pooled analysis demonstrated a significant increase in a composite of death, MI, and RRV (with/without stroke) after DES‐PCI (HR, 1.42; P < 0.00001); no significant difference in a composite of death and MI (with/without stroke); no significant differences in mortality and stroke; a strong trend toward an increase in MI after DES‐PCI (HR, 1.44; P = 0.05); and significant increases in any (HR, 1.86; P < 0.00001), target‐vessel (HR, 3.28; P < 0.00001), and target‐lesion RRV (HR, 2.26; P = 0.003) after DES‐PCI. Conclusions When compared with CABG, DES‐PCI for LMCAD was associated with increases in RRV and the composite of death, MI, and RRV (with/without stroke), despite no differences in mortality, MI, stroke, and the composite of death and MI (with/without stroke).