• Michel Pompeu Barros de Oliveira Sá, Alexandre Magno Macário Nunes Soares, Pablo César Lustosa, Wendell Nunes Martins, Frederico Browne, Paulo Ernando Ferraz, Frederico Pires Vasconcelos, and Ricardo Carvalho Lima.
• Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, Procape Recife, Brazil. michel_pompeu@yahoo.com.br
• Eur J Cardiothorac Surg. 2013 Jan 1; 43 (1): 73-80.

ObjectivesTo compare the safety and efficacy 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.MethodsMEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for clinical studies that reported outcomes at the 1-year follow-up after PCI with DES and CABG for the treatment of ULMCA stenosis. Sixteen studies (three randomized controlled trials and 13 observational studies) were identified and included a total of 5674 patients (2331 for PCI with DES and 3343 for CABG).ResultsAt the 1-year follow-up, there was no significant difference between the CABG and DES groups in the risk for death (odds ratio [OR] 0.691, P = 0.051) or the composite endpoint of death, myocardial infarction or stroke (OR 0.832, P = 0.258). The risk for target vessel revascularization (TVR) was significantly higher in the PCI group compared with the CABG group (OR 3.597, P < 0.001). The risk of major adverse cardiac and cerebrovascular events (MACCE) was significantly higher in the PCI group compared with the CABG group (OR 1.607, P < 0.001). A publication bias was observed regarding the outcome of death and also a considerable heterogeneity effect on the composite endpoint of death, myocardial infarction or stroke and MACCE.ConclusionsCABG surgery remains the best option of treatment for patients with ULMCA disease, with less need of TVR and lower MACCE rates.

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