Objective 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. Methods 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). Results A total of five randomized trials including 4563 subjects were analysed. After an average follow-up of 3.4 years, 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. Conclusion 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.

Benedetto, U., Gaudino, M. F. L., Ng, C., Biondi Zoccai, G., D'ascenzo, F., Frati, G., Girardi, L. N., Angelini, G. D., Taggart, D. P., Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials, <<INTERNATIONAL JOURNAL OF CARDIOLOGY>>, 2016; 210 (210): 19-24. [doi:10.1016/j.ijcard.2016.02.090] [http://hdl.handle.net/10807/93740]

Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials

Gaudino, Mario Fulvio Luigi
Secondo
;
Biondi Zoccai, Giuseppe;
2016

Abstract

Objective 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. Methods 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). Results A total of five randomized trials including 4563 subjects were analysed. After an average follow-up of 3.4 years, 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. Conclusion 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.
Inglese
Benedetto, U., Gaudino, M. F. L., Ng, C., Biondi Zoccai, G., D'ascenzo, F., Frati, G., Girardi, L. N., Angelini, G. D., Taggart, D. P., Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials, <<INTERNATIONAL JOURNAL OF CARDIOLOGY>>, 2016; 210 (210): 19-24. [doi:10.1016/j.ijcard.2016.02.090] [http://hdl.handle.net/10807/93740]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/93740
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