{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:11:04Z","timestamp":1755216664269,"version":"3.43.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>Long-term data are limited comparing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (S-DES) vs coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD). We aimed to conduct a systematic review and meta-analysis comparing these interventions in patients with left main or multivessel CAD. We systematically reviewed PubMed, Embase, and Cochrane for studies that compared PCI with S-DES and CABG in patients with left main or multivessel CAD with a minimum mean follow-up period of 3\u2005years. Outcomes of interest were all-cause mortality, myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). We extracted data from observational studies as multivariable-adjusted or propensity score-matched hazard ratio to minimize confounding and pooled hazard ratios with 95% confidence intervals (CIs) using a random effects model in Review Manager 5.4.1. We included 10 studies, 3 of which were randomized controlled trials, comprising a total of 26964 patients, of whom 14928 underwent PCI. As compared with CABG, S-DES had a significantly higher risk of all-cause mortality (hazard ratio 1.35; 95% CI 1.22\u20131.49; <jats:italic toggle=\"yes\">P<\/jats:italic>\u2005&lt;\u20050.001; <jats:italic toggle=\"yes\">I<\/jats:italic>\n                           <jats:sup>2<\/jats:sup>\u2005=\u20050%), MACE (hazard ratio 1.27; 95% CI 1.08\u20131.50; <jats:italic toggle=\"yes\">P<\/jats:italic>\u2005=\u20050.005; <jats:italic toggle=\"yes\">I<\/jats:italic>\n                           <jats:sup>2<\/jats:sup>\u2005=\u200567%), and MI (hazard ratio 2.43; 95% CI 1.80\u20133.28; <jats:italic toggle=\"yes\">P<\/jats:italic>\u2005&lt;\u20050.01; <jats:italic toggle=\"yes\">I<\/jats:italic>\n                           <jats:sup>2<\/jats:sup>\u2005=\u20050%). There was no significant difference between groups in incidence of stroke. In this meta-analysis of patients with complex CAD, PCI with S-DES was associated with an increased risk of mortality, MI, and MACE compared with CABG.<\/jats:p>","DOI":"10.1097\/mca.0000000000001503","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T07:00:59Z","timestamp":1737356459000},"page":"518-524","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Long-term outcomes of second-generation drug-eluting stents versus coronary artery bypass graft: a systematic review and meta-analysis of randomized trials and multivariable adjusted data"],"prefix":"10.1097","volume":"36","author":[{"given":"Andr\u00e9 Luiz","family":"Carvalho Ferreira","sequence":"first","affiliation":[{"name":"Department of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria E.","family":"Benitez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.E.","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Medicine, Bahiana School of Medicine and Public Health, Salvador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Almir","family":"Alamino Lacalle","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Sao Paulo, Ribeirao Preto"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Saad","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camila Mota","family":"Guida","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Dante Pazzanese Institute 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