title: Risk of stroke with percutaneous coronary intervention compared with on-pump and off-pump coronary artery bypass graft surgery: Evidence from a comprehensive network meta-analysis.
abstract: BACKGROUND
  Although some trials have reported that on-pump coronary artery bypass graft (CABG) surgery may be associated with higher rates of stroke than percutaneous coronary intervention (PCI), whether stroke is more common after off-pump CABG compared with PCI is unknown. We therefore sought to determine whether off-pump CABG is associated with an increased risk of stroke compared with PCI by means of network meta-analysis.
  
  
  METHODS
  Randomized controlled trials (RCTs) comparing CABG vs PCI were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings.
  
  
  RESULTS
  Eighty-three RCTs with 22,729 patients randomized to on-pump CABG (n = 10,957), off-pump CABG (n = 7,119), or PCI (n = 4,653) were analyzed. Thirty-day rates of stroke were significantly lower in patients treated with PCI compared with either off-pump CABG (odds ratio [OR]; 0.39, 95% CI, 0.19-0.83) or on-pump CABG (OR, 0.26; 95% CI, 0.12-0.47). Compared with on-pump CABG, off-pump CABG was associated with significantly lower 30-day risk of stroke (OR, 0.67; 95% CI, 0.41-0.95). However, in sensitivity analyses restricted to high-quality studies, studies with more than either 100 or 1,000 patients, or studies with protocol definition or adjudication of stroke by a clinical events committee, the precision of the point estimate for the 30-day risk of stroke between off-pump vs on-pump CABG was markedly reduced.
  
  
  CONCLUSIONS
  Percutaneous coronary intervention is associated with lower 30-day rates of stroke than both off-pump and on-pump CABG. Further studies are required to determine whether the risk of stroke is reduced with off-pump CABG compared with on-pump CABG.
authors.affiliation: Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Diego Della
authors.initials: DD
authors.lastname: Riva
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.forename: Carlo
authors.initials: C
authors.lastname: Savini
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Philippe
authors.initials: P
authors.lastname: Genereux
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Antonino G M
authors.initials: AG
authors.lastname: Marullo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Teresa
authors.initials: T
authors.lastname: Greco
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Germano
authors.initials: G
authors.lastname: Di Credico
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*