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

Tullio Palmerini, Giuseppe Biondi-Zoccai, Diego Della Riva, Andrea Mariani, Carlo Savini, Marco Di Eusanio, Philippe Genereux, Giacomo Frati, Antonino G.M. Marullo, Giovanni Landoni, Teresa Greco, Angelo Branzi, Stefano De Servi, Germano Di Credico, Nevio Taglieri, Mathew R. Williams, Gregg W. Stone

Research output: Contribution to journalReview article

27 Citations (Scopus)

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 languageEnglish (US)
JournalAmerican Heart Journal
Volume165
Issue number6
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Off-Pump Coronary Artery Bypass
Percutaneous Coronary Intervention
Coronary Artery Bypass
Stroke
Transplants
Odds Ratio
Network Meta-Analysis
Randomized Controlled Trials
MEDLINE

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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. / 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. In: American Heart Journal. 2013 ; Vol. 165, No. 6.
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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 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.).",
author = "Tullio Palmerini and Giuseppe Biondi-Zoccai and Riva, {Diego Della} and Andrea Mariani and Carlo Savini and {Di Eusanio}, Marco and Philippe Genereux and Giacomo Frati and Marullo, {Antonino G.M.} and Giovanni Landoni and Teresa Greco and Angelo Branzi and {De Servi}, Stefano and {Di Credico}, Germano and Nevio Taglieri and Williams, {Mathew R.} and Stone, {Gregg W.}",
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Palmerini, T, Biondi-Zoccai, G, Riva, DD, Mariani, A, Savini, C, Di Eusanio, M, Genereux, P, Frati, G, Marullo, AGM, Landoni, G, Greco, T, Branzi, A, De Servi, S, Di Credico, G, Taglieri, N, Williams, MR & Stone, GW 2013, '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', American Heart Journal, vol. 165, no. 6. https://doi.org/10.1016/j.ahj.2013.03.011

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 journalReview 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.).

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U2 - 10.1016/j.ahj.2013.03.011

DO - 10.1016/j.ahj.2013.03.011

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JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

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