Sá Michel Pompeu Barros de Oliveira, Ferraz Paulo Ernando, Escobar Rodrigo Renda, Nunes Eliobas Oliveira, Soares Alexandre Magno Macário Nunes, Araújo e Sá Frederico Browne Correia de, Vasconcelos Frederico Pires, Lima Ricardo Carvalho
Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco (UPE), Recife, PE, Brazil.
Rev Bras Cir Cardiovasc. 2013 Mar;28(1):83-92. doi: 10.5935/1678-9741.20130013.
To compare the safety and efficacy at long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease.
MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for clinical studies that reported outcomes at 5-year follow-up after PCI with DES and CABG for the treatment of ULMCA stenosis. Five studies (1 randomized controlled trial and 4 observational studies) were identified and included a total of 2914 patients (1300 for CABG and 1614 for PCI with DES).
At 5-year follow-up, there was no significant difference between the CABG and PCI-DES groups in the risk for death (odds ratio [OR] 1.159, P=0.168 for random effect) or the composite endpoint of death, myocardial infarction, or stroke (OR 1.214, P=0.083). The risk for target vessel revascularization (TVR) was significantly lower in the CABG group compared to the PCI-DES group (OR 0.212, P<0.001). The risk of major adverse cardiac and cerebrovascular events (MACCE) was significantly lower in the CABG group compared to the PCI-DES group (OR 0.526, P<0.001). It was observed no publication bias about outcomes and considerably heterogeneity effect about MACCE.
CABG surgery remains the best option of treatment for patients with ULMCA disease, with less need of TVR and MACCE rates at long-term follow-up.
比较冠状动脉旁路移植术（CABG）与使用药物洗脱支架（DES）的经皮冠状动脉介入治疗（PCI）在无保护左主干冠状动脉（ULMCA）疾病患者长期随访中的安全性和疗效。
检索MEDLINE、EMBASE、CENTRAL/CCTR、SciELO、LILACS、谷歌学术以及相关文章的参考文献列表，查找关于DES PCI和CABG治疗ULMCA狭窄后5年随访结果的临床研究。共识别出5项研究（1项随机对照试验和4项观察性研究），纳入患者共2914例（CABG组1300例，DES PCI组1614例）。
在5年随访时，CABG组和PCI-DES组在死亡风险（随机效应的比值比[OR]为1.159，P = 0.168）或死亡、心肌梗死或中风的复合终点方面（OR为1.214，P = 0.083）无显著差异。与PCI-DES组相比，CABG组的靶血管血运重建（TVR）风险显著更低（OR为0.212，P<0.001）。与PCI-DES组相比，CABG组的主要不良心脑血管事件（MACCE）风险显著更低（OR为0.526，P<0.001）。未观察到结局方面的发表偏倚，且MACCE存在相当大的异质性效应。
对于ULMCA疾病患者，CABG手术仍是最佳治疗选择，在长期随访中TVR需求较少且MACCE发生率较低。
