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 offpump 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. (Am Heart J 2013;165:910-917.e14.).
| Original language | English (US) |
|---|---|
| Journal | American Heart Journal |
| Volume | 165 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jan 1 2013 |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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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. / Palmerini, Tullio; Biondi-Zoccai, Giuseppe; Riva, Diego Della; Mariani, Andrea; Savini, Carlo; Di Eusanio, Marco; Genereux, Philippe; Frati, Giacomo; Marullo, Antonino G.M.; Landoni, Giovanni; Greco, Teresa; Branzi, Angelo; De Servi, Stefano; Di Credico, Germano; Taglieri, Nevio; Williams, Mathew R.; Stone, Gregg W.
In: American Heart Journal, Vol. 165, No. 6, 01.01.2013.Research output: Contribution to journal › Review article
TY - JOUR
T1 - Risk of stroke with percutaneous coronary intervention compared with on-pump and off-pump coronary artery bypass graft surgery
T2 - Evidence from a comprehensive network meta-analysis
AU - Palmerini, Tullio
AU - Biondi-Zoccai, Giuseppe
AU - Riva, Diego Della
AU - Mariani, Andrea
AU - Savini, Carlo
AU - Di Eusanio, Marco
AU - Genereux, Philippe
AU - Frati, Giacomo
AU - Marullo, Antonino G.M.
AU - Landoni, Giovanni
AU - Greco, Teresa
AU - Branzi, Angelo
AU - De Servi, Stefano
AU - Di Credico, Germano
AU - Taglieri, Nevio
AU - Williams, Mathew R.
AU - Stone, Gregg W.
PY - 2013/1/1
Y1 - 2013/1/1
N2 - 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 offpump 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. (Am Heart J 2013;165:910-917.e14.).
AB - 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 offpump 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. (Am Heart J 2013;165:910-917.e14.).
UR - http://www.scopus.com/inward/record.url?scp=84880050940&partnerID=8YFLogxK
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U2 - 10.1016/j.ahj.2013.03.011
DO - 10.1016/j.ahj.2013.03.011
M3 - Review article
VL - 165
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 6
ER -