IJCS | Volume 31, Nº2, March / April 2018

160 Andrade et al. Stent versus surgery: randomized trials Int J Cardiovasc Sci. 2018;31(2)152-162 Original Article The MACCE outcomes in subgroups (Figure 7) in the present study demonstrate that the SYNTAX score in the upper tertile strongly and negatively influenced the PCI outcomes, similarly to the presence of diabetes. The elderly condition and the female gender had a small influence on the results; an ejection fraction < 50% did not negatively influence the PCI outcomes, but an ejection fraction < 35% had a greater impact, even though it had no statistical significance. These results are in agreement with those of the collaborative study by Cavalcante et al. 20 In that study, by aggregating the results of the SYNTAX LEFT MAIN and PRECOMBAT for combined adverse events (death, stroke, AMI, and new revascularization), a high SYNTAX score, like diabetes, had an important role. The female gender, elderly condition, ejection fraction < 50%, and renal insufficiency did not negatively affect the results comparedwithPCI. This same study showed that the subgroupsmost significantly affecting PCI‑associated mortality outcomes in obstruction of the left main coronary artery were those with two- or three-vessel disease and with a SYNTAX score > 32. Diabetes had a less important role, possibly related to the fact that only patients with left main coronary artery obstruction were evaluated. Study limitations This study has important limitations. Because the meta‑analysis included published data rather than individual patient data, we were unable to analyze the mortality outcomes in subgroups, except in those with diabetes. Additionally, the percentages had to be processed as absolute numbers, whichmay deserve criticism. The results apply only to patients in whom revascularization is possible by both methods and without a high surgical risk or history of prior surgical revascularization, and with the procedures carried out in institutions of excellence. Conclusion In combined results of randomized studies involving multivessel disease or obstruction of the left main coronary artery, PCI with drug-eluting stent was associated with a lower incidence of stroke, lower mortality at 30 days, and increased late mortality when compared with CABG. There was no difference in early, intermediate, or late mortality in the subgroup with left main coronary obstruction, but there was a difference in favor of PCI in regards to the incidence of stroke. The presence of diabetes and a high SYNTAX score were factors most strongly and negatively impacting PCI outcomes in terms of combined adverse results. Author contributions Conception and design of the research: Andrade PJN. Acquisition of data: Andrade PJN, Falcão JLAA, Andrade AT, Falcão BAA. Analysis and interpretation of the data: Andrade PJN, Rocha HAL, Falcão JLAA, Andrade AT. Statistical analysis: Rocha HAL. Writing of the manuscript: Andrade PJN, Rocha HAL, Falcão JLAA, Falcão BAA. Critical revision of the manuscript for intellectual content:AndradePJN, FalcãoBAA. Supervision / as the major investigador: Andrade PJN. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors.