Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis.
Bottom Line: New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment.Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a trend towards a reduced risk of myocardial infarction (0.75, 0.55 to 1.01).The risk of subsequent revascularisation was noticeably reduced by coronary artery bypass grafting (0.16, 0.13 to 0.20) followed by new generation drug eluting stents (zotarolimus (Resolute): 0.26, 0.17 to 0.40; everolimus: 0.27, 0.21 to 0.35), early generation drug eluting stents (zotarolimus (Endeavor): 0.37, 0.28 to 0.50; sirolimus: 0.29, 0.24 to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and bare metal stents (0.69, 0.59 to 0.81) compared with medical treatment.
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Mentions: Supplemental figure 1 presents the flow chart of the study and summarises the process of identifying trials. We screened the titles and abstracts of 14 888 potentially eligible reports, examined the full text of 620 articles, and identified 399 articles on 100 trials that met our inclusion criteria. Table 1 presents the characteristics of the included trials. The characteristics of the patients and their diseases in the eligible studies are summarised in the supplementary appendix and the characteristics of treatment arms are summarised in table 2. Figure 1 shows the network of evidence. The bare metal stent was investigated most (50 trials) and compared with seven different interventions, whereas the zotarolimus eluting (Resolute) stent was evaluated least (four trials) and compared with three different interventions. For the primary endpoint all cause mortality, the sirolimus eluting stent and bare metal stent had the largest number of patient years (45 879 and 45 467, respectively) and the zotarolimus eluting (Resolute) stent the lowest number (3384 patient years). Overall, 93 553 patients were randomised and we included follow-up of 260 090 patient years in the analysis of the primary endpoint.