Postoperative Outcomes of Left Main Coronary Artery Disease: A Meta-analysis of Randomized Controlled Clinical Trials

Abstract

n patients with unprotected left main coronary artery disease and low to intermediate SYNTAX score, PCI is an acceptable alternative to CABG. PCI was associated with a lower early risk of the composite of MACCE, driven by a lower risk of MI and stroke at the short-term follow-up (30 days). Meanwhile, CABG was associated with a lower risk of the composite of MACCE later on, mainly because of a reduction in the risk of ischemia-driven revascularization at the long-term (>1 year). This gives rise to the potential consideration of PCI as competitive strategy for surgical management of patients with untreated left main coronary artery disease (ULMCA). At long-term follow-up (within 3-5-years), CABG was associated with a lower risk of the composite of MACCE relative to PCI. However we found a statistically significant higher rate of revascularization with PCI compared to CABG on both intermediate term and long term. Lesion location is an important factor for the determination of treatment of choice as well as operator’s experience and technical considerations. Stenting of distal stem or bifurcation lesions is technically challenging and most of the patients are presented with three-vessel disease which makes them good surgical candidates. Although the improvement in stent technology and increased experience of PCI techniques by the operators sometimes make the surgery questionable,