Percutaneous Coronary Intervention Using Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Stenosis A Meta-Analysis of Randomized Trials
Percutaneous Coronary Intervention Using Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Stenosis A Meta-Analysis of Randomized Trials
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DOI：
10.1161/circinterventions.116.004729
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发表时间：
2016-12-01
影响因子：
5.6
通讯作者：
Brown, Adam J.
中科院分区：
文献类型：
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作者：
Nerlekar, Nitesh;Ha, Francis J.;Brown, Adam J.
背景-当前指南建议，冠状动脉旁路移植术（CABG）应该是无保护的左冠状动脉主干狭窄的首选血运重建方法。根据最近随机试验的证据，我们评估了使用药物洗脱支架的经皮冠状动脉介入治疗 (PCI) 是否与 CABG 治疗无保护的左主干冠状动脉疾病一样安全有效。 方法和结果 - 对比较 PCI 和 CABG 治疗无保护的左主干冠状动脉狭窄的随机试验进行了数字数据库和手动搜索。在 3887 项潜在相关研究中，有 5 项符合纳入标准。主要安全终点定义为全因死亡、心肌梗死或中风的复合终点。次要终点包括临床有效性复合终点，其定义为全因死亡、心肌梗塞、卒中或重复血运重建。使用随机效应模型获得了汇总估计。总共有 4594 名患者参与了分析。血运重建策略之间的主要安全终点没有显着差异（比值比 [OR]，0.97；95% 置信区间 [CI]，0.79-1.17；P=0.73）。然而，与 CABG 相比，PCI 的效果较差（OR，1.36；95% CI，1.18-1.58；P
Background-Current guidelines suggest that coronary artery bypass grafting (CABG) should be the preferred revascularization method for unprotected left main coronary artery stenosis. In light of evidence from recent randomized trials, we assessed whether percutaneous coronary intervention (PCI) using drug-eluting stents is as safe and effective as CABG for the treatment of unprotected left main coronary artery disease.Methods and Results-Digital databases and manual searches were performed for randomized trials comparing PCI and CABG for unprotected left main coronary artery stenosis. Among 3887 potentially relevant studies, 5 met inclusion criteria. The primary safety end point was defined as the composite of all-cause death, myocardial infarction, or stroke. Secondary end points included a clinical effectiveness composite, which was defined as all-cause death, myocardial infarction, stroke, or repeat revascularization. Summary estimates were obtained using random-effects modeling. In total, 4594 patients were included in the analysis. There was no significant difference in the primary safety end point between the revascularization strategies (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.79-1.17; P=0.73). However, when compared with CABG, PCI was less effective (OR, 1.36; 95% CI, 1.18-1.58; P