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Meta-Analysis
. 2008 Apr;155(4):624-9, 629.e1-2.
doi: 10.1016/j.ahj.2007.11.005. Epub 2008 Jan 18.

Are "treatment" bare metal stents superior to "control" bare metal stents? A meta-analytic approach

David M Kent  1 , Thomas A Trikalinos
Affiliations
Meta-Analysis

Are "treatment" bare metal stents superior to "control" bare metal stents? A meta-analytic approach

David M Kent et al. Am Heart J. 2008 Apr.

Abstract

Background: It has been suggested that the benefits of drug-eluting stents compared to bare metal stents (BMS) have been overestimated in part because target lesion/vessel revascularization (TLR/TVR) rates in the BMS control group of these trials were spuriously high.

Methods: We used meta-analytic techniques to systematically compare clinical event rates among patients treated with BMS in trials where BMS were the experimental (BMS(experimental)) rather than the control (BMS(control)) intervention. MEDLINE searches were performed to identify eligible randomized trials comparing either drug-eluting stents with BMS(control) or BMS(experimental) with balloon angioplasty in patients with nonacute coronary artery disease. Trial characteristics and 6- to 12-month rates for death, myocardial infarction, TLR/TVR, and major adverse cardiac events were extracted and assessed.

Results: Eligible trials yielded 50 BMS cohorts: 19 in the BMS(control) group (4046 patients) and 31 in the BMS(experimental) group (5068 patients). Summary death and infarction rates did not differ between groups. The summary TLR/TVR rates were 16.2% (95% CI 13.5-19.3) versus 13.8% (95% CI 12.0-15.7) in BMS(control) versus BMS(experimental) groups, respectively (P = .15). Among 39 BMS cohorts with < or = 250 patients, TLR/TVR rates were significantly higher in BMS(control) versus BMS(experimental) groups (18.9% [95% CI 16.0-22.2] vs 13.7% [95% CI 11.5-16.3], P = .01). There were no between-group differences among larger BMS cohorts (P = .98).

Conclusions: Although overall clinical event rates did not differ in the BMS(control) and the BMS(experimental) groups, a higher rate of TVR/TLR was seen in the BMS(control) group among smaller trials.

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Figures

Figure 1
Figure 1
Summary outcome rates in BMScontrol versus BMSexperimental cohorts BMS: bare metal stents; MACE: major cardiac adverse events; MI: myocardial infarction; TLR/TVR: target lesion/vessel revascularization. The figure illustrates the summary event rates (random effects meta-analysis) in the two groups (BMScontrol versus BMSexperimental) for death, MI, TLR/TVR, and MACE. Dots stand for the point estimate of the summary rates and horizontal lines represent the 95% confidence intervals. P-values are for between group differences and are unadjusted for multiple comparisons.
Figure 2
Figure 2
Summary outcome rates for TLR/TVR in BMScontrol versus BMSexperimental cohorts according to sample size. Layout is similar to Figure 1.
See this image and copyright information in PMC

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