Affordable Access

Publisher Website

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

American Heart Journal
Publication Date
DOI: 10.1016/j.ahj.2007.11.005
  • Medicine


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 ≤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.

There are no comments yet on this publication. Be the first to share your thoughts.