Document Detail

Are "treatment" bare metal stents superior to "control" bare metal stents? A meta-analytic approach.
MedLine Citation:
PMID:  18371468     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: It has been suggested that the benefits of drug-eluting stents compared to bare metal stents (BMS) have been overestimated in part because target lesion/vessel revascularization (TLR/TVR) rates in the BMS control group of these trials were spuriously high.
METHODS: We used meta-analytic techniques to systematically compare clinical event rates among patients treated with BMS in trials where BMS were the experimental (BMS(experimental)) rather than the control (BMS(control)) intervention. MEDLINE searches were performed to identify eligible randomized trials comparing either drug-eluting stents with BMS(control) or BMS(experimental) with balloon angioplasty in patients with nonacute coronary artery disease. Trial characteristics and 6- to 12-month rates for death, myocardial infarction, TLR/TVR, and major adverse cardiac events were extracted and assessed.
RESULTS: Eligible trials yielded 50 BMS cohorts: 19 in the BMS(control) group (4046 patients) and 31 in the BMS(experimental) group (5068 patients). Summary death and infarction rates did not differ between groups. The summary TLR/TVR rates were 16.2% (95% CI 13.5-19.3) versus 13.8% (95% CI 12.0-15.7) in BMS(control) versus BMS(experimental) groups, respectively (P = .15). Among 39 BMS cohorts with < or = 250 patients, TLR/TVR rates were significantly higher in BMS(control) versus BMS(experimental) groups (18.9% [95% CI 16.0-22.2] vs 13.7% [95% CI 11.5-16.3], P = .01). There were no between-group differences among larger BMS cohorts (P = .98).
CONCLUSIONS: Although overall clinical event rates did not differ in the BMS(control) and the BMS(experimental) groups, a higher rate of TVR/TLR was seen in the BMS(control) group among smaller trials.
David M Kent; Thomas A Trikalinos
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural     Date:  2008-01-18
Journal Detail:
Title:  American heart journal     Volume:  155     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-28     Completed Date:  2008-04-18     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  624-9, 629.e1-2     Citation Subset:  AIM; IM    
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MeSH Terms
Coronary Disease / therapy*
Myocardial Revascularization / statistics & numerical data
Regression Analysis
Statistics, Nonparametric
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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