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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 4 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—secondary analyses of contemporary trials initiated in 1999 or later. 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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fig4: Fig 4 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—secondary analyses of contemporary trials initiated in 1999 or later. 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: Figure 4 presents results from analyses restricted to 88 contemporary trials which were initiated in 1999 or later, in 85 720 patients. Compared with the main analysis, point estimates of the rate ratio of all cause mortality moved closer to the effect line, and 95% credibility intervals became wider, with a rate ratio of 0.85 for coronary artery bypass grafting (0.72 to 1.00), 0.82 for everolimus eluting stent (0.65 to 1.03), and 0.71 for zotarolimus eluting (Resolute) stent (0.46 to 1.11) compared with medical treatment. For myocardial infarction, the rate ratio for coronary artery bypass grafting moved towards more benefit (0.48, 0.37 to 0.64), and results became statistically more robust for the everolimus eluting stent (0.73, 0.57 to 0.95). For the composite of death or myocardial infarction and for revascularisation, results were similar to the main analysis.


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 4 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—secondary analyses of contemporary trials initiated in 1999 or later. 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

fig4: Fig 4 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—secondary analyses of contemporary trials initiated in 1999 or later. 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: Figure 4 presents results from analyses restricted to 88 contemporary trials which were initiated in 1999 or later, in 85 720 patients. Compared with the main analysis, point estimates of the rate ratio of all cause mortality moved closer to the effect line, and 95% credibility intervals became wider, with a rate ratio of 0.85 for coronary artery bypass grafting (0.72 to 1.00), 0.82 for everolimus eluting stent (0.65 to 1.03), and 0.71 for zotarolimus eluting (Resolute) stent (0.46 to 1.11) compared with medical treatment. For myocardial infarction, the rate ratio for coronary artery bypass grafting moved towards more benefit (0.48, 0.37 to 0.64), and results became statistically more robust for the everolimus eluting stent (0.73, 0.57 to 0.95). For the composite of death or myocardial infarction and for revascularisation, results were similar to the main 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.

View Article: PubMed Central - PubMed

Show MeSH
Related in: MedlinePlus