Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials

被引:170
作者
Bucher, HC [1 ]
Hengstler, P
Schindler, C
Guyatt, GH
机构
[1] Univ Basel, Kantonsspital, Med Poliklin, CH-4031 Basel, Switzerland
[2] Univ Basel, Inst Sozial & Pravent Med, CH-4003 Basel, Switzerland
[3] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada
来源
BMJ-BRITISH MEDICAL JOURNAL | 2000年 / 321卷 / 7253期
关键词
D O I
10.1136/bmj.321.7253.73
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To determine whether percutaneous transluminal coronary angioplasty (angioplasty) is superior to medical treatment in non-acute coronary artery disease. Design Meta-analysis of randomised controlled trials. Setting Randomised controlled trials conducted worldwide and published between 1979 and 1998. Participants 953 patients treated wit angioplasty and 951 with medical treatment from six randomised controlled trials, three of which included patients with multivessel disease and pre-existing myocardial infarction. Main outcome measures Angina, fatal and non-fatal myocardial infarction, death, repeated angioplasty, and coronary artery bypass grafting. Results In patients treated with angioplasty compared wit medical treatment the risk ratios were 0.70 (95% confidence interval 0.50 to 0.98; heterogenicity P>0.001) for angina; 1.42 (0.90 to 2.25) for fatal and non-fatal myocardial infarction, 1.32 (0.65 to 2.70) for death, 1.59 (1.09 to 2.32) for coronary artery bypass graft, and 1.29 (0.71 to 3.36; heterogeneity P < 0.001) for repeated angioplasty. Differences in the methodological quality of the trials, in follow up, or in single versus multivessel disease did not explain the variability in study results in any analysis. Conclusions Percutaneous transluminal coronary angioplasty may lead to a greater reduction in angina in patients with coronary heart disease than medical treatment but at the cost of more coronary artery bypass grafting. Trials have not included enough patients for informative estimates of the effect of angioplasty on myocardial infarction, death, or subsequent revascularisation, though trends so far do not favour angioplasty.
引用
收藏
页码:73 / 77
页数:5
相关论文
共 26 条
[1]   A review of randomized trials comparing coronary angioplasty and bypass grafting [J].
Anderson, WD ;
King, SB .
CURRENT OPINION IN CARDIOLOGY, 1996, 11 (06) :583-590
[2]   Coronary angiography and angioplasty after acute myocardial infarction [J].
Bates, DW ;
Miller, E ;
Bernstein, SJ ;
Hauptman, PJ ;
Leape, LL .
ANNALS OF INTERNAL MEDICINE, 1997, 126 (07) :539-550
[3]  
Chamberlain DA, 1997, LANCET, V350, P461
[4]   METAANALYSIS IN CLINICAL-TRIALS [J].
DERSIMONIAN, R ;
LAIRD, N .
CONTROLLED CLINICAL TRIALS, 1986, 7 (03) :177-188
[5]  
Fleiss J L, 1993, Stat Methods Med Res, V2, P121, DOI 10.1177/096228029300200202
[6]   Percutaneous transluminal coronary angioplasty versus medical therapy for stable angina pectoris - Outcomes for patients with double-vessel versus single-vessel coronary artery disease in a veterans affairs cooperative randomized trial [J].
Folland, ED ;
Hartigan, PM ;
Parisi, AF .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 29 (07) :1505-1511
[7]  
GILLUM BS, 1996, DHHS PUBLICATION 13, V124
[8]  
HIGGINSON LAJ, 1994, CAN J CARDIOL, V10, P728
[9]   THE MEDICINE, ANGIOPLASTY OR SURGERY STUDY (MASS) - A PROSPECTIVE, RANDOMIZED TRIAL OF MEDICAL THERAPY, BALLOON ANGIOPLASTY OR BYPASS-SURGERY FOR SINGLE PROXIMAL LEFT ANTERIOR DESCENDING ARTERY STENOSES [J].
HUEB, WA ;
BELLOTTI, G ;
DEOLIVEIRA, SA ;
ARIE, S ;
DEALBUQUERQUE, CP ;
JATENE, AD ;
PILEGGI, F .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1995, 26 (07) :1600-1605
[10]   Assessing the quality of reports of randomized clinical trials: Is blinding necessary? [J].
Jadad, AR ;
Moore, RA ;
Carroll, D ;
Jenkinson, C ;
Reynolds, DJM ;
Gavaghan, DJ ;
McQuay, HJ .
CONTROLLED CLINICAL TRIALS, 1996, 17 (01) :1-12