Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
5992121 | The Journal of Thoracic and Cardiovascular Surgery | 2011 | 11 Pages |
BackgroundWe performed the present systematic review and meta-analysis of randomized and nonrandomized comparative studies in an attempt to compare the safety and efficacy of drug-eluting stents with coronary artery bypass grafting for patients with coronary artery disease.MethodsTwenty-five eligible comparative studies (1 randomized and 24 nonrandomized) were assessed. Two reviewers independently appraised each study. Meta-analysis was performed by combining the results of reported incidence of morbidity, mortality, and repeat revascularization. The relative risk was used as a summary statistic.ResultsIn these 25 studies 34,278 patients were compared, of whom 18,538 received drug-eluting stents and 15,740 underwent coronary artery bypass grafting. It must be acknowledged that this comparison represented a selected group of patients who received drug-eluting stents or underwent coronary artery bypass grafting. The accumulative incidences of all-cause mortality at 12 months (4.5% vs 4.0%, PÂ =Â .92) and 24 months (6.2% vs 8.4%, PÂ =Â .27) and 30-day myocardial infarction (1.4% vs 2.0%, PÂ =Â .60) were similar, respectively, between the drug-eluting stent and coronary artery bypass grafting groups. Drug-eluting stents were associated with lower rates of all-cause mortality at 30 days (0.9% vs 2.3%, PÂ <Â .001), stroke (0.4% vs 1.7%, PÂ <Â .001), and 30-day major adverse cardiac and cerebrovascular events (3.6% vs 5.5%, PÂ <Â .04). However, the coronary artery bypass grafting group had a lower incidence of postprocedural myocardial infarction (5.5% vs 4.7%, PÂ =Â .03), repeat revascularization (22.2% vs 4.1%, PÂ <Â .001), and 12-month major adverse cardiac and cerebrovascular events (16.7% vs 10.5%, PÂ <Â .001). Subgroup analysis of patients with multivessel coronary artery disease showed similar results.ConclusionsDrug-eluting stents are associated with less periprocedural risks but a higher incidence of postprocedural myocardial infarction, repeat revascularization, and 12-month major adverse cardiac and cerebrovascular events compared with coronary artery bypass grafting.