PCI vs. CABG for left main coronary artery disease: a meta-analysis

Abstract Background The optimal revascularization strategy for patients with left main (LM) coronary artery disease is still controversial. This is systematic review and meta-analysis aims to evaluate the outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents compared to coronary artery bypass graft (CABG) for LM disease. Methods Online electronic databases were systematically reviewed until January 2020 for randomized trials comparing PCI with drug-eluting stents and CABG. Primary outcomes were: all-cause mortality, myocardial infarction (MI), stroke, and repeated revascularization. Secondary outcomes included periprocedural and non-periprocedural MI. The period of follow-up included: 30-days, 1-year, and 5-years. Odds ratio (OR) and 95% confidence interval (CI) were calculated with a fixed-effects model. Results A total of 4,595 patients (5 randomized trials) with LM disease were included. At 30 days and 1 year, PCI was associated with lower incidence of stroke, higher repeated revascularization, and similar odds of mortality and myocardial infarction compared to CABG. At 5 years, PCI was associated with higher rates of MI (OR=1.43 [95% CI, 1.13-1.79], p=0.003) and repeat revascularization (OR=1.89 [95% CI, 1.58-2.26], p Conclusions Patients with LM disease treated with either PCI or CABG do not show any difference in early or 5-year mortality. While CABG was associated with higher stroke rates at 30 days and 1 year, PCI was associated with an increase in MI and need for repeat revascularization at 5 years.