Long-term Outcome Of Percutaneous Coronary Intervention And Coronary Artery Bypass Grafting In The Treatment Of Unprotected Left Main Disease: A Meta Analysis

Background and objective:Left main coronary artery stenosis ? 50% can be diagnosed as left main coronary artery disease.According to whether there is a smooth vascular bridge or a good right-to-left collateral circulation,the left main lesion can be divided into two types: protected and unprotected.The absence of a smooth vascular bridge or a good right-to-left collateral circulation at the same time in the left trunk lesion is referred to as an unprotected left main disease(UPLM).Because the left main blood vessels innervate the whole left heart system,once the blood flow is blocked,severe myocardial ischemia complications,such as ventricular fibrillation,cardiac arrest or cardiogenic shock,are easy to occur,and the mortality rate is high.Therefore,the treatment of UPLM has always been concerned.PCI and CABG are the mainstream of UPLM therapy.This study aims to explore the long-term efficacy and safety of PCI and CABG in the treatment and prognosis of UPLM by searching for recent published clinical studies comparing PCI and CABG in the treatment and prognosis of UPLM.Methods:The PubMed,EMBASE and Cochrane databases were searched to collect the published literature on the long-term follow-up of UPLM on PCI and CABG.The retrieval time was set to be from January 2013 to December 2018.All-cause death,myocardial infarction,cerebrovascular events,and target vessel revascularization were selected as randomized controlled trials.The selected literature was evaluated by two individuals and the data were extracted.According to the results of the heterogeneity analysis of chi-square test,fixed or random effect models are selected.The data mentioned in the literature are selected for statistical analysis using Review Manager 5.Results:Eight trials with a total of 11332 patients were identified.Men accounted for 77.9% and all studies were followed up for at least 3 years.Data analysis showed:(1)There was no significant difference in all-cause mortality(P=0.92)and cerebrovascular events(P=0.08)between the PCI group and the CABG group at 3 years follow-up,but the myocardial infarction rate in the PCI group was not statistically significant.(P<0.0001),the incidence of target vessel revascularization was significantly increased(P<0.0001).(2)Compared with the CABG group in the 5-year follow-up PCI group,the all-cause mortality of the PCI group was significantly lower(P=0.59),and the incidence of cerebrovascular events was slightly elevated(P=0.29),but not statistically significant,but the myocardium The infarction rate(P<0.0001)and the incidence of target vessel revascularization(P<0.0001)were still significantly increased.(3)Compared with the CABG group in the 7-year follow-up PCI group,all-cause mortality(P=0.0004)and cerebrovascular events(P<0.0001)were significantly lower in the PCI group;myocardial infarction rate(P=0.0002),The incidence of target vascular revascularization(P < 0.0001)was still significantly increased.Conclusion:(1)in short-term follow-up,the incidence of cerebrovascular events in PCI group was similar to that in CABG group.With the prolongation of follow-up time,all-cause mortality and incidence of cerebrovascular events decreased significantly.(2)the incidence of myocardial infarction and target vessel revascularization in PCI group was higher than that in CABG group,both in short-term and long-term follow-up.(3)PCI can reduce the incidence of cerebrovascular events and all-cause death in UPLM patients,but increase the rate of coronary events.