Document Detail


Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass surgery for multivessel coronary artery disease: a meta-analysis of data from the ARTS II, CARDia, ERACI III, and SYNTAX studies and systematic review of observational data.
MedLine Citation:
PMID:  20562080     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: The aim of this study was to systematically analyse the available data from trials comparing revascularisation by drug-eluting stent (DES) placement versus coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease (CAD).
METHODS AND RESULTS: We searched PubMed, Medline and several internet sources for randomised controlled trials comparing DES placement to CABG in patients with multivessel coronary artery disease. There were no restrictions on journal type or population studied. Prior to data collection we chose to analyse the prospectively performed trials separately from data obtained retrospectively. Four prospective trials were identified which enrolled a total of 3,895 patients: 1,914 in the DES arm and 1,981 patients in the CABG arm. Pooled analysis of data from these four studies showed that in patients treated DES compared to CABG there was a similar risk of the combined endpoints of death, myocardial infarction and stroke (10.2% versus 10.8%, respectively; RR=0.94 [95% CI=0.77-1.116]; p=0.56), but a significantly higher risk of target vessel revascularisation (TVR) (14.6% versus 6.8%, respectively; RR=2.09 [95% CI=1.72-2.55]; <0.001) and, therefore, a significantly higher risk of MACCE (21.2% versus 16.3%, respectively; RR=1.27 [95% CI=1.09-1.48]; p=0.002). Interestingly, when MACCE rates at one year are used for these trials the risk is equivalent between DES and CABG (14.4% versus 12.5%, respectively; RR=1.05 [95% CI=0.70-1.57]; p=0.83). Analysis of observational data revealed similar findings.
CONCLUSIONS: Overall, PCI with DES placement was safe in patients with multivessel disease compared to CABG, but is associated with a significantly higher risk of TVR.
Authors:
Aaron M From; Firas J Al Badarin; Stephen S Cha; Charanjit S Rihal
Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology     Volume:  6     ISSN:  1969-6213     ISO Abbreviation:  EuroIntervention     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-21     Completed Date:  2010-12-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101251040     Medline TA:  EuroIntervention     Country:  France    
Other Details:
Languages:  eng     Pagination:  269-76     Citation Subset:  IM    
Affiliation:
The Division of Cardiovascular Diseases, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Coronary*
Coronary Artery Bypass*
Coronary Artery Disease / therapy*
Drug-Eluting Stents*
Humans
Randomized Controlled Trials as Topic

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


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