A meta-analysis update: percutaneous coronary interventions.
OBJECTIVE
To update the most recent meta-analysis comparing percutaneous coronary interventions (PCIs) with medical therapy (MT) in patients having stable coronary artery disease (CAD) by including 2 new large trials that double the total number of patients.


METHODS
Meta-analysis was used to update previous meta-analyses of PCIs in stable CAD. Eleven previously analyzed randomized controlled trials (RCTs) and 2 new RCTs were included.


METHODS
Summary estimates of relative risk (RR) are obtained by applying fixed-effects and random-effects models. Statistical tests for assessing between-study heterogeneity and biases are performed. Cumulative estimates and results from influence analysis are reported.


RESULTS
No difference between PCIs and MT alone was found for risk of mortality. There was a 12% increase in the RR of cardiac death or myocardial infarction (MI) associated with PCIs, as well as a 22% increase in the RR of nonfatal MI associated with PCIs. Cumulative analysis favored MT over PCIs as early as 1997, but recent study results have increased confidence in this finding. Because of heterogeneity between studies, no certain conclusions are drawn for the use of PCIs in preventing follow-up PCI or coronary artery bypass graft surgery.


CONCLUSIONS
Recent RCTs comparing PCIs with conservative MT in stable CAD increase confidence in previous findings that the use of PCIs does not offer marginal benefit over that of the use of MT alone for mortality risk, cardiac death or MI, and nonfatal MI.
Cecil
William T
WT
BlueCross BlueShield of Tennessee, 801 Pine St, 1E, Chattanooga, TN 37402, USA. bill_cecil@bcbst.com
Kasteridis
Panagiotis
P
Barnes
John W
JW
Mathis
Rick S
RS
Patric
Ken
K
Martin
Steve
S
D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D016019:Survival Analysis; D013673:Technology Assessment, Biomedical; D016896:Treatment Outcome