Meta-Analysis of Effectiveness of First-Generation Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Disease.
Am J Cardiol. 2012 Oct 15;
Authors: Jiang WB, Zhao W, Huang H, Li CL, Zhang JH, Wang Y, Fu GS
It is controversial whether drug-eluting stents (DESs) are safe and effective when generalized to "real-world" patients with unprotected left main coronary artery disease. This meta-analysis compared the safety and efficacy of DESs to coronary artery bypass grafting (CABG) in real-world patients with unprotected left main coronary artery. We identified comparative, observational, DES versus CABG studies published from January 2000 through May 2012. All studies included ?100 patients and reported end points with follow-ups ?6 months. We included adjusted risk estimates and, when no adjusted estimate was available, crude estimates. Data were grouped according to follow-up times of ?2, ?3, and >3 years. We included data from 25 observational studies representing 7,230 patients. No differences were detected between CABG and DES in overall mortality (?2 years, adjusted risk ratio [RR], 0.83, 95% confidence interval [CI] 0.53 to 1.28; ?3 years, adjusted RR 0.60, 95% CI 0.20 to 1.66; >3 years, adjusted RR 0.58, 95% CI 0.29 to 1.17) or in major adverse cardiac and cerebrovascular events (?2 years, adjusted RR 1.22, 95% CI 0.86 to 1.73; ?3 years, adjusted RR 1.70, 95% CI 1.35 to 2.15; >3 years, adjusted RR 1.23, 95% CI 0.87 to 1.73). Compared to DESs, CABG showed a significant decrease in target vessel revascularization (?2 years, adjusted RR 3.72, 95% CI 2.50 to 5.52; ?3 years, adjusted RR 3.92, 95% CI 2.54 to 6.04; >3 years, adjusted RR 3.45, 95% CI 2.14 to 5.57). In conclusion, DESs and CABG were not significantly different in short- and long-term rates of death or major cardiovascular/cerebrovascular events, but DESs showed a higher risk of target vessel revascularization compared to CABG.
PMID: 23078911 [PubMed - as supplied by publisher]