title: Drug-eluting stents versus coronary artery bypass grafting for the treatment of coronary artery disease: a meta-analysis of randomized and nonrandomized studies.
abstract: BACKGROUND
  We 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.
  
  
  METHODS
  Twenty-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.
  
  
  RESULTS
  In 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%, P = .92) and 24 months (6.2% vs 8.4%, P = .27) and 30-day myocardial infarction (1.4% vs 2.0%, P = .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%, P < .001), stroke (0.4% vs 1.7%, P < .001), and 30-day major adverse cardiac and cerebrovascular events (3.6% vs 5.5%, P < .04). However, the coronary artery bypass grafting group had a lower incidence of postprocedural myocardial infarction (5.5% vs 4.7%, P = .03), repeat revascularization (22.2% vs 4.1%, P < .001), and 12-month major adverse cardiac and cerebrovascular events (16.7% vs 10.5%, P < .001). Subgroup analysis of patients with multivessel coronary artery disease showed similar results.
  
  
  CONCLUSIONS
  Drug-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.
authors.affiliation: Baird Institute for Applied Heart and Lung Surgical Research, Newtown, Australia. tristan.yan@hotmail.com
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Ratnasari
authors.initials: R
authors.lastname: Padang
authors.forename: Chin
authors.initials: C
authors.lastname: Poh
authors.forename: Christopher
authors.initials: C
authors.lastname: Cao
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome