title: Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era.
abstract: BACKGROUND
  We sought to compare, using meta-analytic techniques, bare-metal stent versus balloon angioplasty in the percutaneous treatment of total coronary occlusions by means of a quantitative systematic review and to indicate new avenues for future treatments.
  
  
  METHODS
  MEDLINE and CENTRAL were searched. Inclusion criteria were random allocation, prospective comparison, and intention to treat. Random-effect odds ratios (ORs) with 95% confidence intervals (CIs) for death, myocardial infarction (MI), repeated revascularization, major adverse cardiac events (MACE), and angiographic restenosis and reocclusion were computed.
  
  
  RESULTS
  Nine trials (1409 patients) were included. Death rate was not different in the 2 groups, 0.4% after stenting versus 0.7% after balloon angioplasty (OR 0.72, 95% CI 0.21-2.50). MI rate was significantly increased after stenting (6.7% vs 3.4%, OR 2.06, 95% CI 1.22-3.46), mainly because of a higher rate of periprocedural non-Q-wave MI. By contrast, the risk of repeated revascularization was significantly reduced by stenting (17% vs 32%, OR 0.41, 95% CI 0.31-0.53). This yielded to an overall reduction in the rate of MACE after stenting (23.2% vs 35.4%, OR 0.49, 95% CI 0.36-0.68). Angiographic restenosis and reocclusion were also decreased by stent (41.1% vs 60.9%, OR 0.36, 95% CI 0.23-0.57; 6.8% vs 16%, OR 0.36, 95% CI 0.22-0.59, respectively).
  
  
  CONCLUSIONS
  In total coronary occlusions, stenting yields an important benefit over balloon angioplasty in reduction of MACE, repeated revascularizations, and angiographic restenosis and reocclusion. However, these events remain frequent. Moreover, the finding of an increased rate of periprocedural minor myocardial damage after stenting casts caution. New strategies aimed to reduce the need of repeated revascularizations and periprocedural MIs should be further investigated.
authors.affiliation: S. Raffaele Hospital, Vita e Salute University, Milan, Italy. agostonipf@gmail.com
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia Garcia
authors.forename: Maurizio
authors.initials: M
authors.lastname: Anselmi
authors.forename: Marco
authors.initials: M
authors.lastname: Turri
authors.forename: Eugene P
authors.initials: EP
authors.lastname: McFadden
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015607:Stents