Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021 Guangxi, People's Republic of China.
Trials. 2013 May 8;14:133. doi: 10.1186/1745-6215-14-133.
The clinical application of drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) is still controversial. The purpose of this meta-analysis was to compare the safety and efficacy between DES and CABG for ULMCAD.
Databases of MEDLINE, EMBASE and the Cochrane Library were systematically searched.
Twenty-one studies with 8,413 patients were included in this meta-analysis. The risk was lower in DES than in CABG groups at the early outcomes of death (risk ratio (RR): 0.49, 95% confidence interval (CI): 0.30-0.78), cerebrovascular events (RR: 0.19, 95% CI: 0.08-0.45) and composite endpoint (RR: 0.53, 95% CI: 0.40-0.70); death after 2 years (RR: 0.81, 95% CI: 0.66-0.99), 4 years (RR: 0.69, 95% CI: 0.53-0.90), 5 years (OR: 0.76, 95% CI: 0.61-0.95) and their total effect (RR: 0.79, 95% CI: 0.71-0.87); composite endpoint 1 year (RR: 0.69, 95% CI: 0.58-0.83), 4 years (RR: 0.69, 95% CI: 0.53-0.88), 5 years (RR: 0.74, 95% CI: 0.59-0.92) and their total effect (RR: 0.78, 95% CI: 0.71-0.85). There were no significant differences in the risk for the early outcomes of myocardial infarction (RR: 0.97, 95% CI: 0.68-1.38), death 1 year (OR: 0.81, 95% CI: 0.57-1.15) and 3 years (OR: 0.85, 95% CI: 0.69-1.04), composite endpoint of 2 years (RR: 0.88, 95% CI: 0.72-1.09) and 3 years (RR: 0.87, 95% CI: 0.73-1.04). Nonetheless, there was a lower risk for revascularization associated with CABG from 1 to 5 years and their total effect (RR: 3.77, 95% CI: 3.35-4.26). There was no difference in death, myocardial infarction, cerebrovascular events or revascularization at 1 year between RCT and observational groups.
Our meta-analysis indicates that DES has higher safety but higher revascularization than CABG in patients with ULMCAD in the 5 years after intervention.
药物洗脱支架（DES）或冠状动脉旁路移植术（CABG）治疗无保护左主干冠状动脉疾病（ULMCAD）的临床应用仍存在争议。本荟萃分析的目的是比较 DES 和 CABG 治疗 ULMCAD 的安全性和疗效。
系统检索 MEDLINE、EMBASE 和 Cochrane 图书馆数据库。
本荟萃分析纳入了 21 项研究，共 8413 例患者。DES 组早期结局的死亡率（风险比（RR）：0.49，95%置信区间（CI）：0.30-0.78）、脑血管事件（RR：0.19，95%CI：0.08-0.45）和复合终点（RR：0.53，95%CI：0.40-0.70）的风险低于 CABG 组；2 年（RR：0.81，95%CI：0.66-0.99）、4 年（RR：0.69，95%CI：0.53-0.90）、5 年（OR：0.76，95%CI：0.61-0.95）和总效应（RR：0.79，95%CI：0.71-0.87）的死亡率；复合终点 1 年（RR：0.69，95%CI：0.58-0.83）、4 年（RR：0.69，95%CI：0.53-0.88）、5 年（RR：0.74，95%CI：0.59-0.92）和总效应（RR：0.78，95%CI：0.71-0.85）的风险较低。早期心肌梗死（RR：0.97，95%CI：0.68-1.38）、1 年死亡率（OR：0.81，95%CI：0.57-1.15）和 3 年死亡率（OR：0.85，95%CI：0.69-1.04）、2 年复合终点（RR：0.88，95%CI：0.72-1.09）和 3 年复合终点（RR：0.87，95%CI：0.73-1.04）的风险无显著差异。然而，从 1 年到 5 年，CABG 组的血运重建风险及其总效应（RR：3.77，95%CI：3.35-4.26）较低。随机对照试验和观察性研究组在 1 年时的死亡率、心肌梗死、脑血管事件或血运重建无差异。
本荟萃分析表明，在介入治疗后 5 年内，DES 治疗 ULMCAD 的安全性高于 CABG，但血运重建率较高。
