We conducted a meta-analysis to examine the relative risks of very long-term cardiovascular outcomes after percutaneous coronary intervention(PCI) for left main coronary artery (LMCA) disease in comparison to coronaryartery bypass graft (CABG), because recent meta-analyses consistently showed the equivalent 5-year all-cause mortality risks for LMCA disease between PCI and CABG regardless of diabetes and SYNTAX sore.

MEDLINE was reviewed until October 2025. Relevant reports, comparing very long-term (>= 10 years) cardiovascular outcomes after either PCI or CABG for LMCA disease by adjusting the baselines, were screened by the twoarticle types of individual reports and meta-analysis. The primary endpoint was all-cause mortality. The secondary endpoints were major adverse cardiac or cerebrovascular events (MACCE), and repeat revascularization (RR). Relative risks, 95% confidence intervals (CI), and heterogeneities of randomized-effect meta-analyses were examined.

A total of 2826 patients with LMCA disease in 5 clinical trials were included (PCI group: 1412, CABG group: 1434). The relative risk of PCI for all-cause mortality to CABG was 1.04 (95%CI: 0.87-1.23, p=0.685, I2 =18%). Therelative risks of PCI for MACCE and RR to CABG in 4 trials were 0.99 (95%CI:0.88-1.12, p=0.909, I2=22%) and 1.71 (95%CI: 0.85-3.42, p=0.130, I2 =90%),respectively.

 A total of 2826 patients with LMCA disease in 5 clinical trials were included (PCI group: 1412, CABG group: 1434). Revascularization for LMCA disease with either PCI or CABG showed the equivalent very long-term cardiovascular outcomes.