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 |
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| Affiliation: | 1. Department of Cardiology, LSUHSC-Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA;2. LSUHSC-Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA;3. Division of Pharmaceutical Evaluation & Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA;4. Department of Medicine, LSUHSC-Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA;1. Kingston General Hospital, Division of Cardiology, Kingston, Ontario, Canada;2. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Division of Cardiology, Quebec City, Quebec, Canada;1. Oklahoma State University Center for Health Sciences, Dept. of Institutional Research, United States of America;2. Oklahoma State University Medical Center, Internal Medicine, United States of America;3. Oklahoma State University Medical Center, Cardiology, United States of America;1. Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA;2. Vanderbilt University Medical Center, Nashville, TN, USA;3. VA North Texas Health Care System, University of Texas Southwestern Medical Center at Dallas, TX, USA;4. Minneapolis Heart Institute, Minneapolis, MN, USA;5. Division of Cardiology, Department of Internal Medicine, Texas Tech University, TX, USA;6. Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA, USA;7. University of Arizona College of Medicine, Tucson, AZ, USA;1. SSM Health St. Mary''s Hospital, St. Louis, Missouri;2. Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio;3. Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon;4. Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia;1. Guthrie Clinic/Robert Packer Hospital, Sayre, PA, USA;2. Mercy Health, Janesville, WI, USA;3. Rutgers Medical School, Newark, NJ;4. The Commonwealth Medical College, Scranton, PA |
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| Abstract: | ![]()
BackgroundMost 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).MethodsWe 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.ResultsWe 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).ConclusionsOur 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. |
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