Outcomes of Coronary Artery Bypass and Stents for Unprotected Left Main Coronary Stenosis

Abstract

Background: This study assessed the short-, medium-, and long-term outcomes of coronary artery bypass grafting vs stenting for patients with unprotected left main coronary artery disease through a meta-analysis of randomized controlled trials.

Methods: PubMed, Embase, Scopus, Web of Science, Cochrane Library, and major conference proceedings databases were systematically searched for randomized controlled trials of coronary artery bypass grafting compared with stents in unprotected left main coronary artery disease. End points assessed were all-cause death, myocardial infarction, major adverse cardiac and cerebrovascular events, target vessel revascularization, and cerebral stroke. A meta-analysis was conducted according to predefined clinical end points.

Results: All-cause death and stroke were similar between stenting and coronary artery bypass grafting at 1 year and at follow-up beyond 1 year. The incidence of myocardial infarction was similar between stenting and coronary artery bypass grafting at each separate time point. The incidence of repeat revascularization was similar between the two groups at 30 days but was higher for stenting at 1 year and beyond. There was a trend toward fewer major adverse cardiac and cerebrovascular events after stenting compared with coronary artery bypass grafting at 30 days, but this difference was no longer significant at 1 year and reversed at follow-up beyond 1 year.

Conclusions: The early advantages of stenting over coronary artery bypass grafting have been shown to progressively shift to coronary artery bypass grafting over time. Further larger sample randomized controlled trials are warranted to confirm the results.