Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials

Hlatky, Mark A.; Boothroyd, Derek B.; Bravata, Dena M; Boersma, Eric; Booth, Jean; Brooks, Maria M.; Carrié, Didier; Clayton, Tim; Danchin, Nicolás; Flather, Marcus; Hamm, Christian W.; Hueb, Whady; Kähler, Jan; Kelsey, Sheryl F.; King, Spencer B.; Kosinski, Andrzej S.; Lopes, Neuza; McDonald, Kathryn M; Rodriguez, Alfredo; Serruys, Patrick W.; Sigwart, Ulrich; Stables, Rod; Owens, Douglas K; Pocock, Stuart J.

doi:10.1016/s0140-6736(09)60552-3

Cited by 663 publications

(479 citation statements)

References 35 publications

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“…Most patients in these RCTs actually had normal LV function with single or double vessel CAD and without proximal LAD disease. Meta-analyses of these RCTs reported that CABG resulted in up to a five-fold reduction in the need for reintervention, with either no or a modest survival benefit or a survival benefit only in patients >65 years old (HR 0.82) and those with diabetes (HR 0.7) [29]. The 5-year follow-up of the MASS II [53] study of 611 patients (underpowered) reported that the composite primary endpoint (total mortality, Q-wave MI, or refractory angina requiring revascularization) occurred in 36% of OMT, 33% of PCI and 21% of CABG patients (P = 0.003), with respective subsequent revascularization rates of 9%, 11% and 4% (P = 0.02).…”

Section: Coronary Artery Bypass Grafting Vs Medical Therapymentioning

confidence: 99%

“…They are at increased risk, including longterm mortality, compared with non-diabetic patients [29], whatever the mode of therapy used, and they may pose specific problems, such as higher restenosis and occlusion rates after PCI and CABG.…”

Section: Special Conditions 91 Diabetesmentioning

confidence: 99%

“…Type of intervention: coronary artery bypass grafting vs. percutaneous coronary intervention All RCTs have shown higher rates of repeat revascularization procedures after PCI, compared with CABG, in diabetic patients [29]. A recent meta-analysis on individual data from 10 RCTs of elective myocardial revascularization [29] confirms a distinct survival advantage for CABG over PCI in diabetic patients. Five-year mortality was 20% with PCI, compared with 12.3% with CABG (OR 0.70, 95% CI 0.56 0.87), whereas no difference was found for nondiabetic patients; the interaction between diabetic status and type of revascularization was significant.…”

Section: Indications For Myocardial Revascularizationmentioning

confidence: 99%

“…IIa B [29,34,113,116] In patients with known renal failure undergoing PCI, metformin may be stopped 48 h before the procedure.…”

Section: Cmentioning

confidence: 99%

See 3 more Smart Citations

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

Self Cite

238

317

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Section: Coronary Artery Bypass Grafting Vs Medical Therapymentioning

confidence: 99%

Section: Special Conditions 91 Diabetesmentioning

confidence: 99%

Section: Indications For Myocardial Revascularizationmentioning

confidence: 99%

“…IIa B [29,34,113,116] In patients with known renal failure undergoing PCI, metformin may be stopped 48 h before the procedure.…”

Section: Cmentioning

confidence: 99%

See 2 more Smart Citations

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

Self Cite

238

317

View full text Add to dashboard Cite

“…Neointima formation (vascular smooth muscle proliferation) following arterial injury is the basis of restenosis, which continues to limit revascularization of patients with arterial disease [70]. In keeping with their roles in cell proliferation, miRs are key participants in neointimal development.…”

Section: Micrornas: Small But Powerful Controllers Of Cardiac Developmentioning

confidence: 99%

The genetics of cardiovascular disease: new insights from emerging approaches

Chico¹,

Milo²,

Crossman³

2009

The Journal of Pathology

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The prospect that sequencing the human genome would see rapid translation of a greater understanding of cardiovascular genetics into novel diagnostics and therapeutics has so far met with only limited success. However, diverse technological advances and exploitation of novel animal models of cardiovascular development and disease are providing ever more insight into cardiovascular diseases and development, and bring closer the prospect of 'postgenomic' diagnostics and therapies. Here we review some of these emerging approaches (genome wide association studies, deep sequencing, microRNA regulation, and zebrafish as a model of cardiovascular disease and development) and discuss their potential for finally fulfilling the promise of application to clinical cardiovascular medicine.

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Cautionary Tales in the Interpretation of Clinical Studies Involving Older Persons

Scott

Guyatt²

2010

Arch Intern Med

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The care of patients 65 years or older presents a challenge for evidence-based medicine. Such patients are underrepresented in clinical trials, are more vulnerable to treatment-induced harm, and often are unable to fully participate in treatment decisions. We outline several cautionary themes in the interpretation of clinical studies of therapeutic interventions involving older persons as they apply to processes of everyday clinical decision making. In particular, we focus on issues of study design and quality of evidence, choice of outcome measures, missing outcome data, assessment of potential harm, quantifying treatment effects in individual patients (and adjusting these for effect modifiers and reduced life expectancy), eliciting patient values and preferences, prioritizing therapeutic goals and selection of treatments, and assisting patients in adhering to agreed therapeutic regimens.

show abstract

Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials

Cited by 663 publications

References 35 publications

Guidelines on myocardial revascularization

Guidelines on myocardial revascularization

The genetics of cardiovascular disease: new insights from emerging approaches

Cautionary Tales in the Interpretation of Clinical Studies Involving Older Persons

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