IJCS | Volume 31, Nº2, March / April 2018

156 –0.2 –0.1 0.2 0 0.1 Favours stent Favours CABG Heterogeneity: Chi 2 = 7.53, df = 8 (p = 0.48); I 2 = 0% Test for overall effect: Z = 5.37 (p = 0.00001) Total events 16 65 Subtotal (95% CI) 4204 70.5% 4184 –0.01 [–0.02, –0.01] Boudriot et al. 2011 0 100 2 101 1.7% –0.02 [–0.05, 0.01] CARDIa 2010 1 254 7 248 4.2% –0.02 [–0.05, –0.05] EXCEL 2010 5 948 12 948 15.9% –0.01 [–0.02, 0.00] FREEDOM 2012 3 953 16 947 16.0% –0.01 [–0.02, –0.00] NOBLE 2016 1 593 4 592 10.0% –0.01 [–0.01, 0.00] PRECOMBAT 2011 0 300 2 300 5.0% –0.01 [–0.02, 0.00] SYNTAX LM 2009 6 903 19 897 15.1% –0.01 [–0.03, –0.00] VA-CARDIS 2013 0 101 1 97 1.7% –0.01 [–0.04, 0.02] LE MANS 2008 0 52 2 54 0.9% –0.04 [–0.10, 0.02] Study or Subgroup Stent Events Total Weight Risk Difference Risk Difference M-H, Fixed, 95% CI CABG Events Total M-H, Fixed, 95% CI Figure 4 – Stroke: stent versus coronary artery bypass grafting. The size of the boxes is proportional to the number of patients. The bars represent 95% confidence intervals. The diamond represents the synthesis of the results. Abbreviations: CABG: coronary artery bypass grafting; SYNTAX: Synergy between PCI with Taxus and Cardiac Surgery; CARDia: Coronary Artery Revascularization in Diabetes; LE MANS: Left Main Coronary Artery Stenting; FREEDOM: Future Revascularization Evaluation in Patients with Diabetes Mellitus; VA CARDS: Coronary Artery Revascularization in Diabetes; BEST: Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease; PRECOMBAT: Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease; EXCEL: Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization; NOBLE: Nordic-Baltic-British Left Main Revascularization Study; Boudriot: study by Boudriot et al.: J Am Coll Cardiol. 2011; 57: 538-545 . Graph obtained using the software Review Manager (RevMan), version 5.3. –0.2 –0.1 0.2 0 0.1 Favours stent Favours CABG Heterogeneity: Chi 2 = 3.60, df = 5 (p = 0.61); I 2 = 0% Test for overall effect: Z = 1.33 (p = 0.18) Total events 71 87 Total (95% CI) 2349 100.0% 2341 –0.01 [–0.02, 0.00] Boudriot et al. 2011 2 100 5 101 4.3% –0.03 [–0.08, 0.02] EXCEL 2010 38 948 38 948 40.4% 0.00 [–0.02, 0.02] LE MANS 2008 1 52 4 52 2.2% –0.06 [–0.14, 0.02] NOBLE 2016 9 592 17 592 25.2% –0.01 [–0.03, 0.00] SYNTAX LM 2013 15 357 15 348 15.0% –0.00 [–0.03, 0.03] PRECOMBAT 2011 6 300 8 300 12.8% –0.01 [–0.03, 0.02] Study or Subgroup Stent Events Total Weight Risk Difference Risk Difference M-H, Fixed, 95% CI CABG Events Total M-H, Fixed, 95% CI Figure 5 – Studies including the left main coronary artery. Mortality at 1 year: Stent versus coronary artery bypass grafting. The size of the boxes is proportional to the number of patients. The bars represent 95% confidence intervals. The diamond represents the synthesis of the results. Abbreviations: CABG: coronary artery bypass grafting; LE MANS: Left Main Coronary Artery Stenting; SYNTAX LM: left main coronary artery subgroup of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery); PRECOMBAT: Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease; EXCEL: Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization; NOBLE: Nordic-Baltic-British Left Main Revascularization; Boudriot: study by Boudriot et al.: J Am Coll Cardiol. 2011; 57: 538-545 . Graph obtained using the software Review Manager (RevMan), version 5.3. Andrade et al. Stent versus surgery: randomized trials Int J Cardiovasc Sci. 2018;31(2)152-162 Original Article Discussion Several systematic reviews, collaborative studies, and meta-analyses 13-18 have been published comparing PCI and CABG. The most important ones included studies of the balloon and bare-metal stent era or left out important recent studies. 14-16 Themain differential of the present meta-analysis is the large number of included studies and patients and the fact that it is up-to-date and included only trials of the drug-eluting stent era.