Meta-Analysis Compares DES and BMS in Left Main Disease

June 25, 2010—Sanjay B. Pandya, MD, et al undertook a meta-analysis to assess outcomes for drug-eluting stents (DES) and bare-metal stents (BMS) in percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis. The investigators reported their findings in the Journal of the American College of Cardiology: Cardiovascular Interventions (2010;3:602–611).

According to the investigators, uncertainty exists regarding the relative performance of DES versus BMS in PCI for ULMCA.

Of a total of 838 studies, 44 met inclusion criteria (n = 10,342) for this meta-analysis. The coprimary endpoints were mortality, myocardial infarction (MI), target vessel/lesion revascularization (TVR/TLR), and major adverse cardiac events (MACE: mortality, MI, TVR/TLR).

The investigators reported that event rates for DES and BMS were calculated at 6 to 12 months, at 2 years, and at 3 years. Crude event rates at 3 years were mortality (8.8% and 12.7%), MI (4% and 3.4%), TVR/TLR (8% and 16.4%), and MACE (21.4% and 31.6%). Nine studies were included in a comparative analysis (n = 5,081). At 6 to 12 months the adjusted odds ratios (OR) for DES versus BMS were: mortality, 0.94 (95% confidence interval [CI], 0.06–15.48; P = .97); MI, 0.64 (95% CI, 0.19–2.17; P = 0.47); TVR/TLR, 0.1 (95% CI, 0.01–0.84; P = .01); and MACE, 0.34 (95% CI, 0.15–0.78; P = .01). At 2 years, the OR for DES versus BMS were: mortality, 0.42 (95% CI, 0.28–0.62; P < .01); MI, 0.16 (95% CI, 0.01–3.53; P = 0.13); and MACE, 0.31 (95% CI, 0.15–0.66; P < .01). At 3 years, the OR for DES versus BMS were: mortality, 0.7 (95% CI, 0.53–0.92; P = .01); MI, 0.49 (95% CI, 0.26–0.92; P = 0.03); TVR/TLR, 0.46 (95% CI, 0.30–0.69; P < .01); and MACE, 0.78 (95% CI, 0.57–1.07; P = .12).

This meta-analysis suggests that DES is associated with favorable outcomes for mortality, MI, TVR/TLR, and MACE as compared to BMS in PCI for ULMCA, concluded the investigators.