ABC | Volume 112, Nº5, May 2019

Original Article Andrade et al Stent versus CABG: a meta-analysis Arq Bras Cardiol. 2019; 112(5):511-523 Figure1 – Stent versus CABG: 30 days mortality (top) and stroke (bottom). The size of each box is proportional to the number of patients of the trial. The bars represent 95% confidence interval. The diamond represents the syntheses of results. DES: trials of the drug-eluting stent era. BMS: trials of the bare-metal stent trials era. CABG: coronary artery bypass grafting. ARTS: Arterial Revascularization Therapies Study; AWESOME: Angina with extremely severe outcomes; ERACI II: Argentine randomized study: coronary angioplasty with stenting versus coronary bypass surgery in patients with multi-vessel disease; MASS II: Medicine, Angioplasty, or Surgery Study; SOS: Stent or Surgery trial; BEST: Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multi-vessel Coronary Artery; Boldriot, trial of Boldriot et al: J Am Coll Cardiol. 2011; 57: 538-545. CARDia: Coronary artery revascularization in diabetic; LE MANS: Left main coronary artery stenting; EXCEL: Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization; FREEDOM: Future Revascularization Evaluation in Patients with Diabetes Mellitus NOBLE, Nordic-Baltic-British Left Main Revascularization Study; PRECOMBAT: Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease; SYNTAX: Synergy between PCI with Taxus and Cardiac Surgery; Va-Cards: Coronary Artery Revascularization in Diabetes in VA Hospitals. –0.2 –0.1 0.1 0.2 0 –0.2 –0.1 0.1 0.2 0 Favours stent Favours CABG Favours stent Favours CABG 1140 1160 25.3% –0.01 [–0.02, 0.00] 3383 3392 74.7% –0.01 [–0.01, –0.00] 4523 4552 100.0% –0.01 [–0.01, –0.00] 1740 1765 29.4% –0.01 [–0.02, –0.00] 4204 4192 70.6% –0.01 [–0.02, –0.01] 5944 5957 100.0% –0.01 [–0.01, –0.01] 7 12 12 5 1 2 5 4 18 30 222 232 5.0% –0.02 [–0.06, 0.02] –0.01 [–0.02, 0.00] –0.01 [–0.04, 0.02] –0.00 [–0.01, 0.01] –0.01 [–0.02, 0.00] –0.04 [–0.10, 0.02] –0.01 [–0.02, 0.00] –0.02 [–0.04, 0.01] –0.01 [–0.02, 0.01] –0.00 [–0.02, 0.02] –0.01 [–0.02, 0.01] –0.02 [–0.05, 0.01] –0.01 [–0.02, 0.01] –0.02 [–0.05, 0.01] –0.01 [–0.02, 0.00] –0.01 [–0.02, –0.00] –0.04 [–0.10, 0.02] –0.01 [–0.01, 0.00] –0.01 [–0.02, 0.00] –0.01 [–0.04, 0.02] –0.01 [–0.03, –0.00] –0.02 [–0.05, –0.00] –0.04 [–0.08, –0.01] –0.00 [–0.03, 0.03] 0.01 [–0.00, 0.02] 5.0% 4.5% 10.9% 225 203 500 225 205 488 3 438 442 9.7% 2.2% 21.0% 20.9% 1.2% 13.0% 6.6% 101 957 947 53 592 300 100 948 953 52 592 300 0 9 8 0 2 4 26 51 44 81 18 9 600 605 232 225 203 500 222 225 205 488 2 0 2 5 13 3 2 6 10 34 16 0 100 101 248 957 947 53 592 300 897 97 254 948 953 52 593 300 903 101 1 5 3 0 1 0 0 6 65 34 99 9 7 2 15 10 1 7 10.1% 3.8% 3.8% 3.4% 8.3% 2 7 12 16 2 2 19 1 4 1.7% 4.2% 16.0% 16.0% 0.9% 10.0% 5.0% 15.1% 1.7% 1.2.1 BMS Subtotal (95% Cl) 1.2.2 DES 1.1.1 BMS 1.1.2 DES Subtotal (95% Cl) Subtotal (95% Cl) Subtotal (95% Cl) Total (95% Cl) Total (95% Cl) 30 day mortality AWESOME 2001 ERACI II 2001 MASS II 2004 SOS 2004 BEST 2015 Boudriot et al 2011 EXCEL 2016 FREEDOM 2012 LE MANS 2008 NOBLE 2016 PRECOMBAT 2011 CARDIA 2010 SYNTAX 2009 VA-CARDIS 2013 Boudriot et al 2011 EXCEL 2016 FREEDOM 2012 LE MANS 2008 NOBLE 2016 PRECOMBAT 2011 ARTS 2001 Stroke AWESOME 2001 ERACI II 2001 MASS II 2004 SOS 2002 Total events Test for overall effect: Z = 1.70 (p = 0.09) Heterogeneity: Chi 2 = 17.99, df = 3 (p = 0.0004); I 2 = 83% Total events Test for overall effect: Z = 2.83 (p = 0.005) Heterogeneity: Chi 2 = 3.65, df = 6 (p = 0.72); I 2 = 0% Total events Test for overall effect: Z = 3.28 (p = 0.001) Test for subgroup differences: Chi 2 = 0.18, df = 1 (p = 0.67); I 2 = 0% Heterogeneity: Chi 2 = 19.42, df = 10 (p = 0.04); I 2 = 49% Total events Test for overall effect: Z = 5.56 (p < 0.00001) Test for subgroup differences: Chi 2 = 0.36, df = 1 (p = 0.55); I 2 = 0% Heterogeneity: Chi 2 = 8.25, df = 13 (p = 0.83); I 2 = 0% Total events Test for overall effect: Z = 2.17 (p = 0.03) Heterogeneity: Chi 2 = 1.00, df = 4 (p = 0.91); I 2 = 0% Total events Test for overall effect: Z = 5.37 (p < 0.00001) Heterogeneity: Chi 2 = 7.59, df = 8 (p = 0.47); I 2 = 0% Study or Subgroup Stent CABG Risk Difference Risk Difference Events Total Events Total Weight M-H, Fixed, 95% Cl M-H, Fixed, 95% Cl 515