Abstract 8894: Comparison of More Than 3 Years Clinical Outcomes Between Drug-eluting Stent and Bypass Surgery for Unprotected Left Main Coronary Artery Disease: A Meta Analysis of Randomised and Risk Adjusted Studies

Backgrounds: Previous data from meta analysis have reported controversial the short and midterm clinical outcomes between drug-eluting stent (DES) and coronary bypass surgery graft (CABG) for paitents with unprotected left main coronary artery disease (ULMCD). However, the long-term outcomes remain unknown. Methods: A systemic research was carried out in Pubmed, Embase, Cochrane library and scientific sessions of AHA, ACC and ESC (up to April 2012). All randomised and nonrandomised studies after >=3 years of follow-up comparing DES and CABG in ULMCD were included. In order to control the potential confoundings in observational studies, risk adjusted hazard ratio (HR) or odds ratio (OR) by propensity score matching or Cox regresson method was abstracted. Results: 10 eligible studies (2 randomised, 8 nonrandomised) wth 6782 subjects were identified and selected. Mortality, death/MI/stroke and target vessel revascularizaton(TVR) were focused. Pooled analysis revealed that there was no statistical significant difference between DES and CABG in mortality (OR=0.92, 95% confidential interval [CI]: 0.65 to 1.31, P=0.646, heterogeniety test: 0.0%; Fig 1) and death/MI/stroke (OR=1.03, 95% CI: 0.75 to 1.42, P=0.841, heterogeniety test: 0.0%).However, compared with CABG, DES had a significant increased incidence of TVR(OR=3.45, 95% CI: 2.38 to 4.99, P<0.00001, heterogeniety test: 0.0%). No evidence of significant publication bias was observed in mortality (Begg’s test, P=0.245; Egger’s test, P=0.518). Sensitivity analysis of mortality excluding each included study at one time revealed that most individual study was consisted with the direction and size of the overall effect ( all P>0.1). Conclusions: Based on the available evidence, after long-term follow up, the mortality and composite outcome are similar between DES and CABG in patients with ULMCD, however, incidence of TVR is still high in DES comparing with CABG.