Meta-analysis Of 5-year Follow-up Outcome Of Percutaneous Coronary Intervention And Coronary Artery Bypass Grafting For Unprotected Left Main Disease

Background: Currently,several randomized controlled studies have shown that drug-eluting stents(DES)for the treatment of left main coronary stenosis are safe and feasible in the short term.However,its long-term(?5 years)treatment effect is still controversial,so we conducted a meta-analysis of the existing data to compare DES with coronary artery bypass grafting(CABG)for unprotected left main coronary artery disease(ULMCAD)Long-term efficacy.Methods: A long-term follow-up(?5 years)study of percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG)for unprotected left main coronary arteries(ULMCAD)was retrieved through databases such as Pubmed,Cochrane,Embase,etc.The included studies were randomized controlled studies or observational studies with propensity score analysis.Study endpoints should include death,myocardial infarction,stroke,and repeated revascularization.Data were extracted from the literature that met the selection criteria,and then the corresponding quality evaluation was performed.In this analysis,Rev Man 5.3 was selected for meta-analysis.Results: Finally,7 studies were included,involving4 randomized controlled studies and 3 observational studies with propensity-score analysis.Drug eluting stents were used in each study.A total of 7,185 patients were enrolled,3,622 in the PCI group and 3,563 in the GABA group.At least 5 years of follow-up showed that the major adverse cardiovascular and cerebrovascular events(the composite endpoint of all-cause death,stroke,myocardial infarction,or repeated revascularization)in the PCI group were significantly increased(HR: 1.35,95% CI 1.22 to 1.51,p < 0.00001),but there was no significant statistical difference in the composite endpoints of death,myocardial infarction,and stroke(HR: 1.03,95% CI 0.90 to 1.17,P = 0.71).There was no difference in all-cause mortality(HR: 1.09,95% CI 0.95 to 1.26,P = 0.22)and stroke(HR: 0.68,95% CI 0.36 to 1.30,P = 0.25)in the PCI and CABG groups,but the incidence of myocardial infarction(HR: 1.62,95% CI 1.12 to 2.35,P=0.01)and repeated revascularization(HR: 2.30,95% CI 1.71 to 3.09,P <0.00001)after PCI Significantly increased.Conclusion: Compared with CABGA,the major adverse cardiovascular and cerebrovascular events,myocardial infarction,and repeated revascularization rates increased after 5 years follow-up after PCI,and the risk of all-cause death and stroke was comparable.