Revascularization versus medical therapy for the treatment of stable coronary artery disease: A meta-analysis of contemporary randomized controlled trials

被引：19

作者：

Laukkanen, Jari A. ^{[1
,2
,3
]}

Kunutsor, Setor K. ^{[4
,5
,6
]}

机构：

[1] Univ Eastern Finland, Inst Clin Med, Dept Med, POB 1627, FIN-70211 Kuopio, Finland

[2] Cent Finland Hlth Care Dist, Dept Med, Jyvaskyla, Finland

[3] Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Kuopio, Finland

[4] Univ Hosp Bristol & Weston NHS Fdn Trust, Bristol Biomed Res Ctr, Natl Inst Hlth Res, Bristol, Avon, England

[5] Univ Bristol, Bristol, Avon, England

[6] Univ Bristol, Bristol Med Sch, Translat Hlth Sci, Southmead Hosp, Learning & Res Bldg Level 1, Bristol, Avon, England

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2021年 / 324卷

关键词：

Revascularization; Percutaneous coronary intervention; Coronary-artery bypass grafting; Medical therapy; Coronary artery disease; Meta-analysis; CONTROLLED CLINICAL-TRIAL; ST-SEGMENT ELEVATION; MYOCARDIAL-INFARCTION; MASS-II; TASK-FORCE; FOLLOW-UP; ANGIOPLASTY; INTERVENTION; MANAGEMENT; SURGERY;

D O I：

10.1016/j.ijcard.2020.10.016

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: We conducted a systematic review and meta-analysis of contemporary randomized controlled trials (RCTs) to compare clinical outcomes among stable coronary artery disease (CAD) patients treated with revascularization [percutaneous coronary intervention (PCI), coronary-artery bypass grafting (CABG) or both] plus medical therapy (MT) versus MT alone. Methods: Prospective RCTs were sought from MEDLINE, Embase, The Cochrane Library, and Web of Science up to April 2020. Data was extracted on study characteristics, methods, and outcomes. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled for the composite of all-cause mortality, myocardial infarction (MI), revascularizations, rehospitalizations, or stroke; its individual components and other cardiovascular endpoints. Results: Twelve unique RCTs comprising of 15,774 patients were included. There was no significant difference in all-cause mortality risk (0.95, 95% CI: 0.86-1.06); however, revascularization plus MT reduced the risk of the composite outcome of all-cause mortality, MI, revascularizations, rehospitalizations, or stroke (0.69, 95% CI: 0.55-0.87); unplanned revascularization (0.53, 95% CI: 0.40-0.71); and fatal MI (0.65, 95% CI: 0.49-0.84). Revascularization plus MT reduced the risk of stroke at 1 year (0.44, 95% CI: 0.30-0.65) and unplanned revascularization and the composite outcome of all-cause mortality, MI, revascularizations, rehospitalizations, or stroke at 2-5 years. Conclusions: Revascularization plus MT does not confer survival advantage beyond that of MT among patients with stable CAD. However, revascularization plus MT may reduce the overall risk of the combined outcome of mortality, MI, revascularizations, rehospitalizations, or stroke, which could be driven by a decrease in the risk of unplanned revascularizations or fatal MI. (C) 2020 Elsevier B.V. All rights reserved.Y

引用

页码：13 / 21

页数：9

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