Evidence map›Paper›PMID 32118272›Full record

SynthesisEuropean heart journal2020

Mortality after drug-eluting stents vs. coronary artery bypass grafting for left main coronary artery disease: a meta-analysis of randomized controlled trials.

Yousif Ahmad, James P Howard, Ahran D Arnold, Christopher M Cook, Megha Prasad, Ziad A Ali, Manish A Parikh, Ioanna Kosmidou, Darrel P Francis, Jeffrey W Moses and 4 more

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
48citing papers in PubMed, 4 pooled it
26.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

48 citing papers in PubMed, 4 syntheses or guidelines pooled it, 159 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Trial
  6. Trial
  7. Review
  8. Review
  9. Observational
  10. Observational
  11. The First-in-Man Technique of Drug Eluting and Perfusion Therapy for Left Main Coronary Artery Disease.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025
    Article
  12. Observational
  13. Review
  14. Review
  15. Coronary artery bypass graftingJournal of thoracic disease · 2024
    Article
  16. Chronic Coronary Disease in Older Adults.The Medical clinics of North America · 2024
    Review
  17. Review
  18. Article
  19. Revascularization strategy for left main coronary artery disease.Indian journal of thoracic and cardiovascular surgery · 2023
    Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 3 institutions in 2 countries.

Yousif AhmadCenter for Interventional Vascular Therapy, Columbia University Medical Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
James P HowardNational Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK.
Ahran D ArnoldNational Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK.
Christopher M CookNational Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK.
Megha PrasadCenter for Interventional Vascular Therapy, Columbia University Medical Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
Ziad A AliCenter for Interventional Vascular Therapy, Columbia University Medical Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
Manish A ParikhCenter for Interventional Vascular Therapy, Columbia University Medical Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
Ioanna KosmidouCenter for Interventional Vascular Therapy, Columbia University Medical Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
Darrel P FrancisNational Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK.
Jeffrey W MosesCenter for Interventional Vascular Therapy, Columbia University Medical Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
Martin B LeonCenter for Interventional Vascular Therapy, Columbia University Medical Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
Ajay J KirtaneCenter for Interventional Vascular Therapy, Columbia University Medical Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
Gregg W StoneThe Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA.
Dimitri KarmpaliotisCenter for Interventional Vascular Therapy, Columbia University Medical Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
NewYork–Presbyterian Hospital · USImperial College London · GBMount Sinai Hospital · US

Funding

British Heart Foundation FS 04/079Medical Research Council MR/M018369/1Wellcome Trust 212183/Z/18/Z
6 · The paper itself

Abstract

aimsThe optimal method of revascularization for patients with left main coronary artery disease (LMCAD) is controversial. Coronary artery bypass graft surgery (CABG) has traditionally been considered the gold standard therapy, and recent randomized trials comparing CABG with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have reported conflicting outcomes. We, therefore, performed a systematic review and updated meta-analysis comparing CABG to PCI with DES for the treatment of LMCAD. METHODS AND

resultsWe systematically identified all randomized trials comparing PCI with DES vs. CABG in patients with LMCAD. The primary efficacy endpoint was all-cause mortality. Secondary endpoints included cardiac death, myocardial infarction (MI), stroke, and unplanned revascularization. All analyses were by intention-to-treat. There were five eligible trials in which 4612 patients were randomized. The weighted mean follow-up duration was 67.1 months. There were no significant differences between PCI and CABG for the risk of all-cause mortality [relative risk (RR) 1.03, 95% confidence interval (CI) 0.81-1.32; P = 0.779] or cardiac death (RR 1.03, 95% CI 0.79-1.34; P = 0.817). There were also no significant differences in the risk of stroke (RR 0.74, 95% CI 0.35-1.50; P = 0.400) or MI (RR 1.22, 95% CI 0.96-1.56; P = 0.110). Percutaneous coronary intervention was associated with an increased risk of unplanned revascularization (RR 1.73, 95% CI 1.49-2.02; P < 0.001).

conclusionThe totality of randomized clinical trial evidence demonstrated similar long-term mortality after PCI with DES compared with CABG in patients with LMCAD. Nor were there significant differences in cardiac death, stroke, or MI between PCI and CABG. Unplanned revascularization procedures were less common after CABG compared with PCI. These findings may inform clinical decision-making between cardiologists, surgeons, and patients with LMCAD.

Indexed as

Coronary Artery DiseaseDrug-Eluting StentsPercutaneous Coronary InterventionCoronary Artery BypassHumansRandomized Controlled Trials as TopicTreatment OutcomeCABGLeft main stemPCI

Identifiers

PMID32118272
PMCPMC7557472
OpenAlexW3010435445

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.