Risk of Stroke With CABG Surgery Compared With PCI
Risk of Stroke With CABG Surgery Compared With PCI
RCT comparing CABG versus PCI in patients with single-vessel CAD, multivessel CAD, and unprotected left main CAD in which the rate of stroke at 30 days, midterm follow-up, or both were included. The primary end point was the 30-day rate of stroke with CABG versus PCI. The secondary end point was the risk of stroke at the midterm follow-up.
Relevant trials were identified through MEDLINE, Cochrane, and EMBASE database searches using the keywords coronary angioplasty, coronary artery bypass, single-vessel coronary artery disease, multivessel coronary artery disease, and left main coronary artery disease. Two investigators (T.P., L.A.) independently reviewed the titles, abstracts, and studies to determine whether they met the inclusion criteria. Conflicts between reviewers were resolved by consensus.
Data from RCT comprised the primary analysis set, whereas data from observational studies were considered secondary. The odds ratio (OR) and 95% confidence interval (CI) were used as the summary statistic. The pooled OR was calculated by using both fixed-effect (inverse variance-weighted) and random-effect (DerSimonian and Laird) models. Median follow-up and number needed to harm were calculated as previously described for meta-analysis. Potential interactions between revascularization method and the extent of CAD on the risk of stroke also were analyzed. Sensitivity analysis, between-study heterogeneity of effects, and publication bias were assessed as previously described. Statistical analyses were performed using Stata/SE software version 11.2 (StataCorp LP, College Station, Texas). Values of p < 0.05 were considered statistically significant.
Methods
Patients and End Points
RCT comparing CABG versus PCI in patients with single-vessel CAD, multivessel CAD, and unprotected left main CAD in which the rate of stroke at 30 days, midterm follow-up, or both were included. The primary end point was the 30-day rate of stroke with CABG versus PCI. The secondary end point was the risk of stroke at the midterm follow-up.
Data Source and Study Selection
Relevant trials were identified through MEDLINE, Cochrane, and EMBASE database searches using the keywords coronary angioplasty, coronary artery bypass, single-vessel coronary artery disease, multivessel coronary artery disease, and left main coronary artery disease. Two investigators (T.P., L.A.) independently reviewed the titles, abstracts, and studies to determine whether they met the inclusion criteria. Conflicts between reviewers were resolved by consensus.
Statistical Analysis
Data from RCT comprised the primary analysis set, whereas data from observational studies were considered secondary. The odds ratio (OR) and 95% confidence interval (CI) were used as the summary statistic. The pooled OR was calculated by using both fixed-effect (inverse variance-weighted) and random-effect (DerSimonian and Laird) models. Median follow-up and number needed to harm were calculated as previously described for meta-analysis. Potential interactions between revascularization method and the extent of CAD on the risk of stroke also were analyzed. Sensitivity analysis, between-study heterogeneity of effects, and publication bias were assessed as previously described. Statistical analyses were performed using Stata/SE software version 11.2 (StataCorp LP, College Station, Texas). Values of p < 0.05 were considered statistically significant.
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