# A Systematic Review and Meta-Analysis of 35,409 Patients Undergoing PCI versus CABG for Unprotected Left Main Coronary Artery Diseases

## TL;DR

This study compares two heart treatments for a serious condition and finds that each has different risks and benefits.

## Contribution

The study provides a comprehensive meta-analysis of 35,409 patients comparing PCI and CABG for UPLM disease.

## Key findings

- CABG had lower major adverse events, mainly due to fewer revascularizations.
- PCI had lower stroke rates and fewer deaths, heart attacks, and stent issues.
- More research is needed to determine the best treatment strategy.

## Abstract

Patients with unprotected left main
(UPLM) disease who underwent percutaneous coronary intervention (PCI) were found
to have inconsistent results compared to those treated with coronary artery
bypass grafting (CABG).

We identified and enrolled randomized
controlled trials (RCTs) and observational studies (OSs) comparing PCI
versus CABG for UPLM disease. A meta-analysis was performed using Stata
17.0. The primary endpoints were major adverse cardiovascular and cerebrovascular
events (MACCEs). Additionally, all-cause death, cardiac death, myocardial
infarction (MI), stroke, target vessel revascularization (TVR), and stent
thrombosis (ST) were included as secondary endpoints. The odds ratios and 95%
confidence intervals (CIs) were calculated. Sensitivity analyses were implemented
if I2
> 50% or p
< 0.01. Publication bias analysis was
conducted if more than 10 studies were included.

A total of 5
RCTs and 18 OSs involving 35,409 patients were included. The CABG strategy had a
significantly lower incidence of MACCEs, primarily due to TVR. A significantly
lower stroke rate was observed with the PCI strategy, as well as a significantly
lower all-cause death, cardiac death, MI, and ST rate compared with the CABG
strategy.

MACCE rates were significantly lower in patients
who underwent CABG, primarily due to TVR, but stroke rates were higher. RCTs with
different study types need further investigation to confirm the most effective
strategy.