IJCS | Volume 31, Nº2, March / April 2018

DOI: 10.5935/2359-4802.20180005 Abstract Background: The choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) remains controversial. Objective: To conduct a meta-analysis of randomized studies comparing drug-eluting stents (DES) and CABG in multivessel disease or obstruction of the left main coronary artery. Method: Electronic databases were searched systematically to evaluate results of randomized trials comparing PCI with DES versus CABG in multivessel disease and obstruction of the left main coronary artery. Ten studies were identified. Results: In the aggregated results (n = 9268), mortality at 30 days and incidence of stroke favored PCI (0.8% versus 1.5%, p = 0.005; 0.4% versus 1.5%, p < 0.0001, respectively). There was no difference in mortality at 1 year (3.4% versus 3.5%, p = 0.50). The late mortality favored CABG (10.1% versus 8.5%, p = 0.01). In patients with diabetes derived from four studies (n = 3830), latemortality favored CABG (12.5%versus 9.7%, p < 0.0001). In six studies of left main coronary artery obstruction (n = 4700), the incidence of stroke favored PCI (0.3% versus 1.5%, p < 0.001) and there was no difference in mortality at 30 days (0.8% versus 1.3%, p = 0.15), mortality at 1 year, or late mortality (8.1% versus 8.1%). The subgroups with high SYNTAX score and diabetes were those influencing most strongly and adversely the PCI results. Conclusion: When compared with PCI, CABG was superior in regards to late mortality and inferior in regards to 30-day mortality and incidence of stroke. Diabetes and SYNTAX score strongly impacted the results. (Int J Cardiovasc Sci. 2018;31(2)152-162) Keywords: Myocardial Revascularization; Drug Eluting Stents; Randomized Controlled Trials as Topic; Meta-Analysis. 152 International Journal of Cardiovascular Sciences. 2018;31(2)152-162 ORIGINAL ARTICLE Mailing address: Pedro José Negreiros de Andrade Francisco Holanda, 992, Ap.: 1101. Postal Code 60130-040, Dionisio Torres, Fortaleza, CE – Brazil. E-mail: pedroneg@gmail.com ; pedroneg@gmail.com Drug-eluting stents Versus Coronary Artery Bypass Grafting in Multivessel Disease and Left Main Obstruction: Meta-analysis of Randomized Clinical Trials Pedro José Negreiros de Andrade, 1,2 Hermano Alexandre Lima Rocha, 1,3 João Luiz de Alencar Araripe Falcão, 1,2 Antonio Thomaz de Andrade, 1 Breno de Alencar Araripe Falcão 1,4 Hospital Dr. Carlos Alberto Studart Gomes, Messejana, 1 Universidade Federal do Ceará (UFC), 2 Centro Universitário Christus, 3 Universidade Estadual do Ceará (UECE), 4 Fortaleza, CE – Brazil Manuscript received February 13, 2017; revised manuscript May 25, 2017; accepted July 11, 2017 Introduction Percutaneous coronary intervention (PCI or angioplasty) and coronary artery bypass grafting (surgery or CABG) are well-accepted, safe, and effective alternatives in the treatment of coronary insufficiency. A large number of randomized clinical trials has been published comparing both procedures. 1-12 In light of these studies, there seems to be a slight superiority of surgery over PCI in the ability to reduce anginal symptoms and a significant difference in its ability to prevent new revascularization procedures. Such studies are generally undersized to evaluate outcomes like death, stroke, and acute myocardial infarction (AMI). The objective of this studywas to performameta-analysis of randomized clinical trials comparing PCI and CABG in multivessel disease and obstruction of the left main coronary artery in the era of drug-eluting stents, with emphasis on mortality and stroke. Methods Randomized studies comparing PCI with drug-eluting stents versus CABG inmultivessel lesions and/or obstruction of the left main coronary artery published between January 2002 and November 2016 were searched in the databases MEDLINE and Cochrane Library, and in bibliographical