{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:23:25Z","timestamp":1782487405160,"version":"3.54.5"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T00:00:00Z","timestamp":1589155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>A 5-year survival of patients with unprotected left main (ULM) stenosis according to the choice of revascularization (percutaneous vs. surgical) remains to be defined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG) with a follow-up of at least 5\u2009years were included. All-cause death was the primary endpoint. MACCE [a composite endpoint of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization] along with its single components and cardiovascular (CV) death were the secondary ones. Analyses were stratified according to the use of first- vs. last-generation coronary stents. Subgroup comparisons were performed according to SYNTAX score (below or above 33) and to age (using cut-offs of each trial\u2019s subgroup analysis). Four RCTs with 4394 patients were identified: 2197 were treated with CABG, 657 with first generation, and 1540 with last-generation stents. At 5-year rates of all-cause death did not differ [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.71\u20131.21], as those of CV death and stroke. Coronary artery bypass graft reduced rates of MACCE (OR 0.69, 95% CI 0.60\u20130.79), mainly driven by MI (OR 0.48, 95% CI 0.36\u20130.65) and revascularization (OR 0.53, 95% CI 0.45\u20130.64). Benefit of CABG for MACCE was consistent, although with different extent, across values of SYNTAX score (OR 0.76, 95% CI 0.59\u20130.97 for values\u2009&amp;lt;\u200932 and OR 0.63, 95% CI 0.47\u20130.84 for values\u2009\u2265\u200933) while was not evident for \u2018younger\u2019 patients (OR 0.83, 95% CI 0.65\u20131.07 vs. OR 0.65, 95% CI 0.51\u20130.84 for \u2018older\u2019 patients).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>For patients with ULM disease followed-up for 5 years, no significant difference was observed in all-cause and cardiovascular death between PCI and CABG. Coronary artery bypass graft reduced risk of MI, revascularization, and MACCE especially in older patients and in those with complex coronary disease and a high SYNTAX score.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaa041","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T19:13:45Z","timestamp":1588619625000},"page":"476-485","source":"Crossref","is-referenced-by-count":23,"title":["Percutaneous vs. surgical revascularization for patients with unprotected left main stenosis: a meta-analysis of 5-year follow-up randomized controlled trials"],"prefix":"10.1093","volume":"7","author":[{"given":"Fabrizio","family":"D\u2019Ascenzo","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4915-9501","authenticated-orcid":false,"given":"Ovidio","family":"De Filippo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3877-9323","authenticated-orcid":false,"given":"Edoardo","family":"Elia","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6977-0765","authenticated-orcid":false,"given":"Mattia Paolo","family":"Doronzo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Omed\u00e8","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1949-3178","authenticated-orcid":false,"given":"Antonio","family":"Montefusco","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Pennone","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1032-9155","authenticated-orcid":false,"given":"Stefano","family":"Salizzoni","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Conrotto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8011-6844","authenticated-orcid":false,"given":"Guglielmo","family":"Gallone","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Angelini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6221-482X","authenticated-orcid":false,"given":"Luca","family":"Franchin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0019-0273","authenticated-orcid":false,"given":"Francesco","family":"Bruno","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, Corso Bramante 88, 10126, Turin, 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