Drug‐eluting stent placement versus coronary artery bypass surgery for unprotected left main coronary artery disease: A meta‐analysis of randomized controlled trials

BACKGROUND Coronary artery bypass grafting (CABG) is the standard of care for treating left main coronary lesions. However, recently published randomized controlled trials (RCT) have shown conflicting results. We sought to compare clinical outcomes of percutaneous coronary intervention (PCI) with drug‐eluting stent placement to CABG using a meta‐analysis of randomized controlled trials. METHODS A systemic search of Pubmed, Scopus, Cochrane library, and Clinicaltrials.gov was performed for randomized controlled trials comparing PCI with CABG in patients with left main stenosis. Data were analyzed using random effect models and Mantel‐Haenszel methods. The primary outcome was major adverse cardiovascular and cerebral events (MACCE). The secondary outcomes were myocardial infarction, stroke, cardiac, and all‐cause mortality. A subgroup analysis based on SYNTAX score was also performed. RESULTS A total of 4595 patients (2297 in the PCI group and 2298 in the CABG group) from five RCTs were included in the analysis. There were significant differences in MACCE (odds ratio [OR] 1.36, confidence interval [CI] 95%, 1.18‐1.58, p‐value: