Clinical InvestigationInterventional CardiologyA collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease☆
Section snippets
Methods
This review was reported according to established methods,4 minimizing duplication risks.5, 6 BioMedCentral, clinicaltrials.gov, Google Scholar, and PubMed were searched (January 2000-September 2006),6 without language restrictions. Citations were screened at title/abstract level and retrieved as full reports. Studies were included if the following criteria applied: (a) PCI with stent implantation, (b) for ULM disease, (c) using DES, and (d) in ≥20 patients. Exclusion criteria were as follows: (
Results
From 823 initial citations (Figure 1), we excluded 806 hits, leaving 17 studies,9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 (Table I, Table II). The 17 included studies reported on a total of 16 nonduplicate cohorts, enrolling 1278 subjects undergoing PCI with DES for ULM disease. Eight studies were observational reports on 540 patients treated with DES,9, 15, 16, 18, 20, 21, 23, 25 6 studies were nonrandomized comparisons of PCI with DES (n = 576) versus BMS (n = 509),10,
Discussion
The present meta-analysis, reporting on DES implantation for ULM, has the following implications: published reports on DES use now include >1200 subjects, confirming that this treatment option has been already adopted into clinical practice despite the lack of a sound evidence base; although overall results suggest an apparently favorable risk of MACE in selected patients, most studies are fraught with validity threats; moreover, clinical follow-up is to date still limited at the midterm
References (31)
- et al.
Long-term benefits of an early invasive management in acute coronary syndromes significantly depend on intracoronary stenting and aggressive antiplatelet treatment: a metaregression
Am Heart J
(2005) - et al.
Comparison of early outcome of percutaneous coronary intervention for unprotected left main coronary artery disease in the drug-eluting stent era with versus without intravascular ultrasonic guidance
Am J Cardiol
(2005) - et al.
Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: comparison with bare metal stent implantation
J Am Coll Cardiol
(2005) - et al.
Rapamycin-eluting stents for the treatment of unprotected left main coronary disease
Am Heart J
(2004) - et al.
Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease
J Am Coll Cardiol
(2006) - et al.
Drug-eluting stents in patients with left main coronary lesions who are not candidates for surgical revascularization
Rev Esp Cardiol
(2005) - et al.
Comparison between coronary angioplasty and coronary artery bypass surgery for the treatment of unprotected left main coronary artery stenosis (the Bologna Registry)
Am J Cardiol
(2006) - et al.
Serial angiographic follow-up of sirolimus-eluting stents for unprotected left main coronary artery revascularization
J Am Coll Cardiol
(2006) - et al.
Does angiography six months after coronary intervention influence management and outcome? BENESTENT II Investigators
J Am Coll Cardiol
(1999) - et al.
Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials
Am J Med
(2006)
Prevalence of narrowing > or = 50% of the left main coronary artery among 17,300 patients having coronary angiography
Am J Cardiol
The first coronary angioplasties in Zurich
Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected left main coronary artery
Circulation
Drug-eluting stents: an early systematic review to inform policy
Eur Heart J
Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group
JAMA
Cited by (0)
- ☆
Dr Biondi-Zoccai consulted for Boston Scientific, Boston, MA; Cordis, Miami, FL; and Mediolanum Cardio Research, Milan, Italy; and received lecture fees from Bristol-Myers-Squibb, New York, NY. Dr Agostoni has received lecture fees from Cordis.
- 1
Both authors equally contributed to this work.