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European Heart Journal 2004 25(1):69-80; doi:10.1016/j.ehj.2003.10.001
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Clinical outcomes of stents versus balloon angioplasty in non-acute coronary artery disease

A meta-analysis of randomized controlled trials

Alain J Nordmanna,*, Peter Hengstlerb, Bernd M Leimenstollc, Thomas Harrb, James Younga and Heiner C Buchera

a Basel Institute for Clinical Epidemiology, University Hospital Basel, Base, Switzerland
b Medical Outpatient Clinic, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
c Department of Internal Medicine, University Hospital Basel, Basel, Switzerland

* Correspondence to: Alain J. Nordmann, MD MSc, Basel Institute for Clinical Epidemiology, University Hospital Basel, Hebelstrasse 10, 4031 Basel, Switzerland. Tel: +41 61 265 31 00; Fax: +41 61 265 31 09
E-mail address: nordmanna{at}uhbs.ch

Received 22 July 2003; revised 9 September 2003; accepted 3 October 2003

Abstract

Aims To evaluate whether stents as compared to balloon angioplasty reduce mortality in patients with non-acute coronary artery disease.

Methods and results We identified randomized controlled trials comparing stents to balloon angioplasty for the treatment of non-acute coronary artery disease by searching major medical databases from 1979 to March 2002. Two independent reviewers selected and extracted data from trials that had to report data on death and myocardial infarction. Nineteen trials, with a total of 8004 patients, fulfilled our inclusion criteria. For 1000 patients treated with stents rather than balloon angioplasty, 3 (95% CI 0–6), 5 (95% CI 0–9), and 6 (95% CI -1–12) additional lives were saved at 30 days, 6 and 12 months. At 12 months, for 1000 patients treated with stents rather than balloon angioplasty 46 (95% CI 25–66) additional target vessel revascularizations were avoided, but 25 (95% CI 15–34) additional bleeding complications with need for blood transfusion or surgical intervention occurred. In sensitivity analysis 11 (95% CI 2–20) and 2 (95% CI -4–7) deaths were avoided per 1000 patients treated with stents rather than PTCA in trials that routinely used compared to trials that did not use glycoprotein IIb/IIIa inhibitors.

Conclusion In non-acute coronary disease stents may reduce overall mortality, but this benefit seems to be limited to stents used in conjunction with glycoprotein IIb/IIIa inhibitors. Stents compared to PTCA reduce target vessel revascularizations, but increase the risk of bleeding complications.

Key Words: Coronary artery disease • Stents • Angioplasty • Meta analysis


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