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Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery in Left Main Coronary Artery Disease: A Meta-Analysis of Randomized Clinical ...

D Capodanno, GW Stone... - Journal of the ..., 2011 - Am Coll Cardio Found... CI = confidence interval; LEMANS = Left Main Coronary Artery Stenting; MACCE = major adverse cardiac and cerebrovascular event(s); MI = myocardial infarction; PRECOMBAT = Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus ...

Davide Capodanno, MD*,*, Gregg W. Stone, MD, Marie C. Morice, MD, Theodore A. Bass, MD and Corrado Tamburino, MD, Ph D*

Manuscript received May 7, 2011; revised manuscript received June 24, 2011, accepted July 5, 2011.

Objectives: The purpose of this study was to determine the safety and efficacy of percutaneous coronary intervention (PCI) compared with coronary artery bypass graft (CABG) in patients with left main coronary artery (LMCA) disease.

Methods: We identified 1,611 patients from 4 randomized clinical trials for the present meta-analysis. The primary endpoint was the 1-year incidence of major adverse cardiac and cerebrovascular events (MACCE), defined as death, myocardial infarction (MI), target vessel revascularization (TVR), or stroke.

Results: PCI was associated with a nonsignificantly higher 1-year rate of MACCE compared with CABG (14.5% vs. 11.8%; odds ratio [OR]: 1.28; 95% confidence interval [CI]: 0.95 to 1.72; p = 0.11), driven by increased TVR (11.4% vs. 5.4%; OR: 2.25; 95% CI: 1.54 to 3.29; p < 0.001). Conversely, stroke occurred less frequently with PCI (0.1% vs. 1.7%; OR: 0.15; 95% CI: 0.03 to 0.67; p = 0.013). There were no significant differences in death (3.0% vs. 4.1%; OR: 0.74; 95% CI: 0.43 to 1.29; p = 0.29) or MI (2.8% vs. 2.9%; OR: 0.98; 95% CI: 0.54 to 1.78; p = 0.95).