Journal article
Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials.
- Abstract:
- Current randomized controlled trials (RCTs) comparing percutaneous coronary intervention with drug eluting stent (DES-PCI) with coronary artery bypass grafting (CABG) in multivessel disease are underpowered to detect a difference in hard clinical end-points such as mortality, myocardial infarction and stroke. We aimed to overcome this limitation by conducting a meta-analysis of contemporary RCTs.A systematic literature search was conducted for all RCTs comparing DES-PCI versus CABG in multivessel disease published through May 2015. Inverse variance weighting was used to pool data from individual studies (<1 favouring DES-PCI and >1 CABG favouring surgery).A total of five randomized trials including 4563 subjects were analysed. After an average follow-up of 3.4years, DES-PCI was associated with a significantly increased risk of overall mortality (HR 1.51; 95%CI 1.23-1.84; P<0.001), MI (HR 2.02; 95%CI 1.57-2.58; P<0.001) and repeat revascularization (HR 2.54; 95%CI 2.07-3.11; P=<0.001). CABG marginally increased the risk of stroke (HR 0.70; 95%CI 0.50-0.98; P=0.04). The absolute risk reduction for all-cause mortality (3.3%) and myocardial infarction (4.3%) with CABG was larger than the absolute risk reduction for stroke (0.9%) with DES-PCI.In patients with multivessel coronary disease, CABG was found to be superior to DES-PCI by reducing the risk of mortality and subsequent myocardial infarction at the expense of a marginally increased risk of stroke.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Authors
- Publisher:
- Elsevier
- Journal:
- International Journal of Cardiology More from this journal
- Volume:
- 210
- Pages:
- 19-24
- Publication date:
- 2016-02-18
- Acceptance date:
- 2016-02-14
- DOI:
- EISSN:
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1874-1754
- ISSN:
-
0167-5273
- Language:
-
English
- Keywords:
- Pubs id:
-
pubs:609093
- UUID:
-
uuid:f8d5eeb9-fa36-4416-9a3c-010743bd919a
- Local pid:
-
pubs:609093
- Source identifiers:
-
609093
- Deposit date:
-
2016-03-16
Terms of use
- Copyright holder:
- Elsevier
- Copyright date:
- 2016
- Notes:
- © 2016 Elsevier Ireland Ltd. All rights reserved. This is the accepted manuscript version of the article. The final version is available online from Elsevier at: [10.1016/j.ijcard.2016.02.090]
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