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 Figure 5 – Stent versus CABG: risk difference of long-term major composite adverse outcomes (MACCE) in subgroups. The size of each box is proportional to the number of patients of the subgroups. The bars represent 95% confidence interval. The diamond represents the syntheses of results. CABG: coronary artery bypass grafting. LEE = Lee et al, J Am Coll Cardiol Intv 2016; 9:2481–9 (Meta-analysis of individual patient data of SYNTAX, PRECOMBAT and BEST); EXCEL: Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization; FREEDOM, Future Revascularization Evaluation in Patients with Diabetes Mellitus. Low ejection Fraction was defined as < 50% in EXCEL and as < 40% in FREEDOM and LEE. –0.2 –0.1 0.1 0.2 0 Favours stent Favours CABG 1743 1738 9.5% 0.06 [0.03, 0.08] 1799 1814 9.9% 0.02 [–0.00, 0.04] 1330 1361 7.4% 0.03 [0.00, 0.06] 1259 1226 6.8% 0.01 [–0.02, 0.03] 2642 2664 14.5% 0.03 [0.01, 0.05] 901 879 4.9% 0.04 [0.01, 0.08] 200 192 1.1% 0.04 [–0.04, 0.12] 2604 2670 16.6% 0.02 [0.00, 0.04] 1236 1274 7.9% 0.01 [–0.02, 0.04] 797 871 5.2% 0.06 [0.03, 0.10] 257 86 692 1107 466 864 463 898 482 777 485 741 698 722 1222 658 742 1264 256 226 419 289 215 375 21 111 68 11 115 66 620 782 1202 629 786 1255 329 294 613 340 364 570 182 202 413 192 217 462 135 223 88 707 3.8% 6.1% 1107 168 254 82 178 260 67 154 221 55 83 138 68 59 127 94 188 192 474 107 118 161 386 43 67 70 180 20 13 19 52 20 3 16 39 109 143 160 412 111 115 141 367 28 75 77 180 46 58 66 170 37 56 88 181 30 41 71 142 51 94 402 179 47 78 304 953 256 534 947 2012 2016 2017 2016 2017 2016 2017 2016 2017 2016 2012 2017 2016 2012 2017 2016 2012 2017 2016 2012 2017 2016 2012 2017 2016 2012 2017 259 532 5.2% 1.4% 2.9% 2.5% 4.1% 6.8% 2.2% 2.7% 1.3% 1.2% 3.7% 2.0% 2.1% 7.7% 4.9% 3.9% 0.4% 0.6% 0.1% 1.2% 1.5% 4.0% 3.7% 2.6% 4.8% 0.08 [0.04, 0.12] 0.02 [–0.05, 0.09] 0.03 [–0.01, 0.07] –0.00 [–0.03, 0.03] 0.03 [–0.02, 0.08] 0.03 [–0.00, 0.07] 0.03 [–0.00, 0.06] 0.09 [0.05, 0.13] 0.05 [–0.02, 0.12] 0.35 [0.01, 0.68] 0.05 [0.00, 0.09] 0.06 [–0.00, 0.12] 0.09 [0.01, 0.18] 0.04 [–0.03, 0.12] 0.06 [0.01, 0.11] –0.03 [–0.08, 0.02] 0.01 [–0.03, 0.05] 0.02 [–0.01, 0.05] –0.00 [–0.04, 0.03] 0.01 [–0.09, 0.11] 0.04 [–0.11, 0.19] 0.06 [–0.01, 0.13] 0.03 [–0.02, 0.08] 0.03 [0.00, 0.06] –0.01 [–0.05, 0.02] –0.03 [–0.07, 0.02] 0.03 [0.00, 0.06] 28 61 52 141 Subtotal (95% Cl) 1.7.1 Diabetic MetaAdjustedp value forDiabetes:0.03 (Adjusted forAgeandSex) MetaAdjustedp value forDiabetes:0.03 (Adjusted forEjection fraction) MetaAdjustedp value forDiabetes:0.09 (Adjusted forSyntaxScore) MetaAdjustedp value forDiabetes:0.59 (Adjusted forDiabetesandSex) MetaAdjustedp value forSex: 0.06 (Adjusted forDiabetesandAge) MetaAdjustedp value forEjection fraction: 0.05 (Adjusted forDiabetes) MetaAdjustedp value forSyntax: 0.03 (Adjusted forDiabetes) 1.7.2 Non diabetic 1.7.3 Aged 1.7.4 Not aged 1.7.5 Male 1.7.6 Female 1.7.7 Low ejection fraction 1.7.8 Normal ejection fraction 1.7.9 Syntax ≤ 22 1.7.11 Syntax ≥ 32 Total events Test for overall effect: Z = 4.11 (p < 0.0001) Heterogeneity: Chi 2 = 4.26, df = 2 (p = 0.12); I 2 = 53% Subtotal (95% Cl) Total events Test for overall effect: Z = 1.62 (p = 0.11) Heterogeneity: Chi 2 = 1.72, df = 1 (p = 0.19); I 2 = 42% Subtotal (95% Cl) Total events Test for overall effect: Z = 2.26 (p = 0.02) Heterogeneity: Chi 2 = 0.01, df = 1 (p = 0.91); I 2 = 0% Subtotal (95% Cl) Total events Test for overall effect: Z = 0.52 (p = 0.60) Heterogeneity: Chi 2 = 4.25, df = 1 (p = 0.04); I 2 = 76% Subtotal (95% Cl) Total events Test for overall effect: Z = 3.29 (p = 0.0010) Heterogeneity: Chi 2 = 13.33, df = 2 (p = 0.01); I 2 = 85% Subtotal (95% Cl) Total events Test for overall effect: Z = 2.38 (p = 0.02) Heterogeneity: Chi 2 = 0.61, df = 2 (p = 0.74); I 2 = 0% Subtotal (95% Cl) Total events Test for overall effect: Z = 1.02 (p = 0.31) Heterogeneity: Chi 2 = 3.67, df = 2 (p = 0.16); I 2 = 45% Subtotal (95% Cl) Total events Test for overall effect: Z = 2.10 (p = 0.04) Heterogeneity: Chi 2 = 3.04, df = 2 (p = 0.22); I 2 = 34% Subtotal (95% Cl) Total events Test for overall effect: Z = 0.87 (p = 0.39) Heterogeneity: Chi 2 = 5.29, df = 2 (p = 0.07); I 2 = 62% Subtotal (95% Cl) Total events Test for overall effect: Z = 3.29 (p = 0.001) Heterogeneity: Chi 2 = 0.75, df = 2 (p = 0.69); I 2 = 0% EXCEL 2016 EXCEL 2016 FREEDOM 2012 FREEDOM 2012 LEE 2017 LEE 2017 EXCEL 2016 LEE 2017 EXCEL 2016 LEE 2017 EXCEL 2016 LEE 2017 FREEDOM 2012 EXCEL 2016 LEE 2017 FREEDOM 2012 EXCEL 2016 LEE 2017 FREEDOM 2012 EXCEL 2016 LEE 2017 FREEDOM 2012 EXCEL 2016 LEE 2017 FREEDOM 2012 EXCEL 2016 LEE 2017 Study or Subgroup Stent CABG Risk Difference Risk Difference Events Total Events Total Weight Year M-H, Fixed, 95% Cl M-H, Fixed, 95% Cl 519