Journal article
Long term outcomes of new generation drug eluting stents versus coronary artery bypass grafting for multivessel and/or left main coronary artery disease. A Bayesian network meta-analysis of randomized controlled trials
Cardiovascular revascularization medicine, Vol.19(6), pp.671-678
09/2018
DOI: 10.1016/j.carrev.2018.01.003
PMID: 29396239
Abstract
Most data guiding revascularization of multivessel disease (MVD) and/or left main disease (LMD) favor coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI). However, those data are based on trials comparing CABG to bare metal stents (BMS) or old generation drug eluting stents (OG-DES). Hence, it is essential to outcomes of CABG to those of new generation drug eluting stents (NG-DES).
We searched PUBMED and Cochrane database for trials evaluating revascularization of MVD and/or LMD with CABG and/or PCI. A Bayesian network meta-analysis was performed to calculate odds ratios (OR) and 95% credible intervals (CrI). Primary outcome was major adverse cardiovascular events (MACE) at 3–5 years. Secondary outcomes were mortality, cerebrovascular accidents (CVA), myocardial infarction (MI) and repeat revascularization.
We included 10 trials with a total of 9287 patients. CABG was associated with lower MACE when compared to BMS or OG-DES. However, MACE was not significantly different between CABG and NG-DES (OR 0.79, CrI 0.45–1.40). Moreover, there were no significant differences between CABG and NG-DES in mortality (OR 0.78, CrI 0.45–1.37), CVA (OR 0.93 CrI 0.35–2.2) or MI (OR 0.6, CrI 0.17–2.0). On the other hand, CABG was associated with lower repeat revascularization (OR 0.55, CrI 0.36–0.84).
Our study suggests that NG-DES is an acceptable alternative to CABG in patients with MVD and/or LMD. However, repeat revascularization remains to be lower with CABG than with PCI.
•CABG is associated with lower MACE when compared to old generation stents but not when compared to new generation DES.•There is no significant difference between CABG and PCI in mortality, CVA and MI.•CABG is associated with lower repeat revascularization when compared to PCI.
Details
- Title: Subtitle
- Long term outcomes of new generation drug eluting stents versus coronary artery bypass grafting for multivessel and/or left main coronary artery disease. A Bayesian network meta-analysis of randomized controlled trials
- Creators
- George S. Mina - Louisiana State University Health Sciences Center ShreveportHussam Watti - Louisiana State University Health Sciences Center ShreveportDemiana Soliman - Louisiana State University Health Sciences Center ShreveportAnand Shewale - University of Arkansas for Medical SciencesJessica Atkins - Louisiana State University Health Sciences Center ShreveportPratap Reddy - Louisiana State University Health Sciences Center ShreveportPaari Dominic - Louisiana State University Health Sciences Center Shreveport
- Resource Type
- Journal article
- Publication Details
- Cardiovascular revascularization medicine, Vol.19(6), pp.671-678
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.carrev.2018.01.003
- PMID
- 29396239
- ISSN
- 1553-8389
- eISSN
- 1878-0938
- Language
- English
- Date published
- 09/2018
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984367241002771
Metrics
6 Record Views