title: Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis.
abstract: OBJECTIVE
  To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease.
  
  
  METHODS
  Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials while maintaining randomisation.
  
  
  METHODS
  A strategy of initial medical treatment compared with revascularisation by coronary artery bypass grafting or Food and Drug Administration approved techniques for percutaneous revascularization: balloon angioplasty, bare metal stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease.
  
  
  METHODS
  Medline and Embase from 1980 to 2013 for randomised trials comparing medical treatment with revascularisation.
  
  
  METHODS
  All cause mortality.
  
  
  RESULTS
  100 trials in 93,553 patients with 262,090 patient years of follow-up were included. Coronary artery bypass grafting was associated with a survival benefit (rate ratio 0.80, 95% credibility interval 0.70 to 0.91) compared with medical treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment. Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a trend towards a reduced risk of myocardial infarction (0.75, 0.55 to 1.01). The risk of subsequent revascularisation was noticeably reduced by coronary artery bypass grafting (0.16, 0.13 to 0.20) followed by new generation drug eluting stents (zotarolimus (Resolute): 0.26, 0.17 to 0.40; everolimus: 0.27, 0.21 to 0.35), early generation drug eluting stents (zotarolimus (Endeavor): 0.37, 0.28 to 0.50; sirolimus: 0.29, 0.24 to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and bare metal stents (0.69, 0.59 to 0.81) compared with medical treatment.
  
  
  CONCLUSIONS
  Among patients with stable coronary artery disease, coronary artery bypass grafting reduces the risk of death, myocardial infarction, and subsequent revascularisation compared with medical treatment. All stent based coronary revascularisation technologies reduce the need for revascularisation to a variable degree. Our results provide evidence for improved survival with new generation drug eluting stents but no other percutaneous revascularisation technology compared with medical treatment.
authors: Stephan
authors: S
authors: Windecker
authors: Stefan
authors: S
authors: Stortecky
authors: Giulio G
authors: GG
authors: Stefanini
authors: Bruno R
authors: BR
authors: da Costa
authors: Bruno R
authors: BR
authors: daCosta
authors: Anne Wilhelmina
authors: AW
authors: Rutjes
authors: Marcello
authors: M
authors: Di Nisio
authors: Maria G
authors: MG
authors: Silletta
authors: Maria G
authors: MG
authors: Siletta
authors: Ausilia
authors: A
authors: Maione
authors: Fernando
authors: F
authors: Alfonso
authors: Peter M
authors: PM
authors: Clemmensen
authors: Jean-Philippe
authors: JP
authors: Collet
authors: Jochen
authors: J
authors: Cremer
authors: Volkmar
authors: V
authors: Falk
authors: Gerasimos
authors: G
authors: Filippatos
authors: Christian
authors: C
authors: Hamm
authors: Stuart
authors: S
authors: Head
authors: Arie Pieter
authors: AP
authors: Kappetein
authors: Adnan
authors: A
authors: Kastrati
authors: Juhani
authors: J
authors: Knuuti
authors: Ulf
authors: U
authors: Landmesser
authors: Günther
authors: G
authors: Laufer
authors: Franz-Joseph
authors: FJ
authors: Neumann
authors: Dimitri
authors: D
authors: Richter
authors: Patrick
authors: P
authors: Schauerte
authors: Miguel
authors: M
authors: Sousa Uva
authors: David P
authors: DP
authors: Taggart
authors: Lucia
authors: L
authors: Torracca
authors: Marco
authors: M
authors: Valgimigli
authors: William
authors: W
authors: Wijns
authors: Adam
authors: A
authors: Witkowski
authors: Philippe
authors: P
authors: Kolh
authors: Peter
authors: P
authors: Jüni
authors: Peter
authors: P
authors: Juni
mesh_terms: D003324:Coronary Artery Disease / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome