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

Stephan Windecker, Stefan Stortecky, Giulio G Stefanini

    BMJ (Clinical Research Ed.)
    |June 25, 2014
    PubMed

    Insights

    Coronary artery bypass grafting improves survival for stable coronary artery disease patients. New generation drug-eluting stents also show survival benefits, unlike other percutaneous revascularization methods.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Health Outcomes Research

    Background:

    • Stable coronary artery disease (CAD) management involves medical therapy and revascularization.
    • The comparative effectiveness of different revascularization strategies remains an area of active research.

    Purpose of the Study:

    • To compare the prognosis of revascularization versus medical treatment in patients with stable CAD.
    • To evaluate various revascularization techniques, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with different stent types.

    Main Methods:

    • Bayesian network meta-analyses were employed to synthesize evidence from randomized trials.
    • Included 100 trials with 93,553 patients, focusing on all-cause mortality.

    Main Results:

    • Coronary artery bypass grafting (CABG) demonstrated a significant survival benefit compared to medical treatment.
    • New generation drug-eluting stents (everolimus, zotarolimus-Resolute) were associated with improved survival, unlike older stent types or balloon angioplasty.
    • CABG significantly reduced myocardial infarction risk and subsequent revascularization needs. New generation DES also reduced revascularization needs.

    Conclusions:

    • For stable CAD, CABG offers survival advantages and reduces adverse events.
    • New generation drug-eluting stents provide a survival benefit over medical therapy, while other PCI methods do not show similar improvements.
    • All stent-based revascularization technologies reduce the need for repeat procedures to varying extents.
    Abstract

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