Document Detail


Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis.
MedLine Citation:
PMID:  19286090     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Over the past 20 years, percutaneous transluminal balloon coronary angioplasty (PTCA), bare-metal stents (BMS), and drug-eluting stents (DES) succeeded each other as catheter-based treatments for coronary artery disease. We undertook a systematic overview of randomised trials comparing these interventions with each other and with medical therapy in patients with non-acute coronary artery disease.
METHODS: We searched Medline for trials contrasting at least two of the four interventions (PTCA, BMS, DES, and medical therapy). Eligible outcomes were death, myocardial infarction, coronary artery bypass grafting, target lesion or vessel revascularisation, and any revascularisation. Random effects meta-analyses summarised head-to-head (direct) comparisons, and network meta-analyses integrated direct and indirect evidence.
FINDINGS: 61 eligible trials (25 388 patients) investigated four of six possible comparisons between the four interventions; no trials directly compared DES with medical therapy or PTCA. In all direct or indirect comparisons, succeeding advancements in percutaneous coronary intervention did not produce detectable improvements in deaths or myocardial infarction. The risk ratio (RR) for indirect comparisons between DES and medical therapy was 0.96 (95% CI 0.60-1.52) for death and 1.15 (0.73-1.82) for myocardial infarction. By contrast, we recorded sequential significant reductions in target lesion or vessel revascularisation with BMS compared with PTCA (RR 0.68 [0-60.0.77]) and with DES compared with BMS (0.44 [0.35-0.56]). The RR for the indirect comparison between DES and PTCA for target lesion or vessel revascularisation was 0.30 (0.17-0.51).
INTERPRETATION: Sequential innovations in the catheter-based treatment of non-acute coronary artery disease showed no evidence of an effect on death or myocardial infarction when compared with medical therapy. These results lend support to present recommendations to optimise medical therapy as an initial management strategy in patients with this disease.
Authors:
Thomas A Trikalinos; Alawi A Alsheikh-Ali; Athina Tatsioni; Brahmajee K Nallamothu; David M Kent
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Lancet     Volume:  373     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-16     Completed Date:  2009-03-25     Revised Date:  2013-12-19    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  911-8     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Coronary*
Coronary Disease / classification,  mortality,  therapy*
Drug-Eluting Stents*
Female
Humans
Male
Randomized Controlled Trials as Topic
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1UL1 RR025752/RR/NCRR NIH HHS; UL1 RR025752/RR/NCRR NIH HHS; UL1 RR025752-027213/RR/NCRR NIH HHS
Comments/Corrections
Comment In:
Lancet. 2009 Mar 14;373(9667):870-2   [PMID:  19286067 ]
Erratum In:
Lancet. 2009 Aug 1;374(9687):378

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


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