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Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis.

Windecker S, Stortecky S, Stefanini GG, da Costa BR, daCosta BR, Rutjes AW, Di Nisio M, Silletta MG, Siletta MG, Maione A, Alfonso F, Clemmensen PM, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head S, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter D, Schauerte P, Sousa Uva M, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A, Kolh P, Jüni P, Juni P - BMJ (2014)

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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Fig 3 Estimated rate ratios (95% credibility intervals) for mortality, myocardial infarction, the composite of death or myocardial infarction, and subsequent revascularisation from network meta-analyses for different revascularisation modalities compared with medical treatment—overall analyses. Square size is proportional to statistical precision of estimates. CABG=coronary artery bypass grafting; PTCA=percutaneous transluminal coronary angioplasty; BMS=bare metal stents; PES=paclitaxel eluting stent; SES=sirolimus eluting stent; E-ZES=zotarolimus eluting (Endeavor) stent; R-ZES=zotarolimus eluting (Resolute) stent; EES=everolimus eluting stent
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fig3: Fig 3 Estimated rate ratios (95% credibility intervals) for mortality, myocardial infarction, the composite of death or myocardial infarction, and subsequent revascularisation from network meta-analyses for different revascularisation modalities compared with medical treatment—overall analyses. Square size is proportional to statistical precision of estimates. CABG=coronary artery bypass grafting; PTCA=percutaneous transluminal coronary angioplasty; BMS=bare metal stents; PES=paclitaxel eluting stent; SES=sirolimus eluting stent; E-ZES=zotarolimus eluting (Endeavor) stent; R-ZES=zotarolimus eluting (Resolute) stent; EES=everolimus eluting stent

Mentions: In general, trials were considered to be of high methodological quality. Appropriate methods of allocation concealment were described for 71 trials (71%). Fifty six trials (56%) reported blind adjudication of clinical outcomes, and for 69 trials (69%) we were able to include all randomised patients into the analysis according to the intention to treat principle. Supplementary table 2 presents the raw numbers of events separately for each trial at the follow-up closest to five years. Supplementary table 3 provides a breakdown of the number of patients, events, and accumulated patient years by intervention. Figure 2 provides the cumulative number of patients randomly assigned to different types of intervention over time. Figure 3 presents the rate ratios of clinical outcomes of revascularisation compared with medical treatment.


Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis.

Windecker S, Stortecky S, Stefanini GG, da Costa BR, daCosta BR, Rutjes AW, Di Nisio M, Silletta MG, Siletta MG, Maione A, Alfonso F, Clemmensen PM, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head S, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter D, Schauerte P, Sousa Uva M, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A, Kolh P, Jüni P, Juni P - BMJ (2014)

Fig 3 Estimated rate ratios (95% credibility intervals) for mortality, myocardial infarction, the composite of death or myocardial infarction, and subsequent revascularisation from network meta-analyses for different revascularisation modalities compared with medical treatment—overall analyses. Square size is proportional to statistical precision of estimates. CABG=coronary artery bypass grafting; PTCA=percutaneous transluminal coronary angioplasty; BMS=bare metal stents; PES=paclitaxel eluting stent; SES=sirolimus eluting stent; E-ZES=zotarolimus eluting (Endeavor) stent; R-ZES=zotarolimus eluting (Resolute) stent; EES=everolimus eluting stent
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4066935&req=5

fig3: Fig 3 Estimated rate ratios (95% credibility intervals) for mortality, myocardial infarction, the composite of death or myocardial infarction, and subsequent revascularisation from network meta-analyses for different revascularisation modalities compared with medical treatment—overall analyses. Square size is proportional to statistical precision of estimates. CABG=coronary artery bypass grafting; PTCA=percutaneous transluminal coronary angioplasty; BMS=bare metal stents; PES=paclitaxel eluting stent; SES=sirolimus eluting stent; E-ZES=zotarolimus eluting (Endeavor) stent; R-ZES=zotarolimus eluting (Resolute) stent; EES=everolimus eluting stent
Mentions: In general, trials were considered to be of high methodological quality. Appropriate methods of allocation concealment were described for 71 trials (71%). Fifty six trials (56%) reported blind adjudication of clinical outcomes, and for 69 trials (69%) we were able to include all randomised patients into the analysis according to the intention to treat principle. Supplementary table 2 presents the raw numbers of events separately for each trial at the follow-up closest to five years. Supplementary table 3 provides a breakdown of the number of patients, events, and accumulated patient years by intervention. Figure 2 provides the cumulative number of patients randomly assigned to different types of intervention over time. Figure 3 presents the rate ratios of clinical outcomes of revascularisation compared with medical treatment.

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.

View Article: PubMed Central - PubMed

Show MeSH
Related in: MedlinePlus