IJCS | Volume 31, Nº2, March / April 2018

158 –0.2 –0.1 0.2 0 0.1 Favours stent FavoursCABG Heterogeneity:Chi 2 = 3.63, df= 4 (p= 0.46); I 2 = 0% Test for overall effect:Z= 4.90 (p= 0.00001) Total events 419 301 Subtotal (95%CI) 1714 14.1% 1708 0.00 [–0.02, 0.02] BEST2015 34 177 17 186 1.5% 0.10 [0.03, 0.17] EXCEL2016 51 256 47 259 2.1% 0.02 [–0.05, 0.09] FREEDOM 2012 257 953 179 947 7.8% 0.08 [0.04, 0.12] PRECOMBAT2011 23 102 15 90 0.8% 0.06 [–0.05, 0.17] SYNTAX LM 2009 54 226 43 226 1.9% 0.05 [–0.03, 0.12] StudyorSubgroup 1.7.1Patientswithdiabetes Heterogeneity:Chi 2 = 5.24, df= 4 (p= 0.26); I 2 = 24% Test for overall effect:Z= 0.54 (p= 0.59) Total events 207 204 Subtotal (95%CI) 1338 11.2% 1395 0.00 [–0.02, 0.03] BEST2015 24 185 23 186 1.5% 0.01 [–0.06, 0.07] EXCEL2016 28 294 46 364 2.7% –0.03 [–0.08, 0.02] FREEDOM 2012 75 329 58 340 2.8% 0.06 [–0.00, 0.12] PRECOMBAT2011 16 128 13 104 0.9% 0.00 [–0.09, 0.09] SYNTAX LM 2009 64 402 64 401 3.3% –0.00 [–0.03, 0.12] 1.7.9SYNTAX lower tertile Heterogeneity:Chi 2 = 2.11, df= 4 (p= 0.72); I 2 = 0% Test for overall effect:Z= 3.63 (p= 0.0003) Total events 196 148 Subtotal (95%CI) 816 7.0% 871 0.07 [0.03, 0.11] BEST2015 13 66 10 79 0.6% 0.07 [–0.05, 0.19] EXCEL2016 37 220 30 217 1.8% 0.03 [–0.04, 0.10] FREEDOM 2012 56 182 41 192 1.5% 0.09 [0.01, 0.18] PRECOMBAT2011 14 58 13 68 0.5% 0.05 [–0.09, 0.19] SYNTAX LM 2009 76 290 54 315 2.5% 0.09 [0.03, 0.16] 1.7.10SYNTAXupper tertile Heterogeneity:Chi 2 = 0.73, df= 3 (p= 0.87); I 2 = 0% Test for overall effect:Z= 2.56 (p= 0.01) Total events 145 114 Subtotal (95%CI) 688 5.8% 710 0.05 [0.01, 0.09] BEST2015 22 134 13 137 1.1% 0.07 [–0.01, 0.15] EXCEL2016 43 226 28 215 1.8% 0.06 [–0.01, 0.13] FREEDOM 2012 67 256 61 289 2.2% 0.05 [–0.02, 0.12] PRECOMBAT2011 13 72 12 69 0.6% 0.01 [–0.12, 0.13] 1.7.6Femalegender Heterogeneity:Chi 2 = 4.47, df= 2 (p= 0.11); I 2 = 55% Test for overall effect:Z= 1.28 (p= 0.20) Total events 40 27 Subtotal (95%CI) 149 1.2% 143 0.06 [–0.03, 0.05] BEST2015 7 17 4 17 0.1% 0.18 [–0.13, 0.49] EXCEL2016 20 111 20 115 0.9% 0.01 [–0.09, 0.11] FREEDOM 2012 13 21 3 11 0.1% 0.35 [0.01, 0.68] 1.7.7Reduced ejection fraction Heterogeneity:Chi 2 = 3.87, df= 2 (p= 0.14); I 2 = 48% Test for overall effect:Z= 2.09 (p= 0.04) Total events 312 269 Subtotal (95%CI) 1823 15.1% 1840 0.03 [0.00, 0.05] BEST2015 60 421 43 425 3.5% 0.04 [–0.00, 0.09] EXCEL2016 109 782 111 786 6.5% –0.00 [–0.04, 0.03] FREEDOM 2012 143 620 115 629 5.2% 0.05 [0.00, 0.09] 1.7.8Non-reduced ejection fraction Heterogeneity:Chi 2 = 1.83, df= 3 (p= 0.61); I 2 = 0% Test for overall effect:Z= 1.42 (p= 0.16) Total events 281 252 Subtotal (95%CI) 1830 14.1% 1842 0.02 [–0.01, 0.04] BEST2015 33 261 30 256 2.1% 0.01 [–0.05, 0.07] EXCEL2016 86 692 88 707 5.8% –0.00 [–0.03, 0.03] PRECOMBAT2011 29 198 27 210 1.7% 0.02 [–0.05, 0.08] SYNTAX LM 2009 133 679 107 669 5.6% 0.04 [–0.00, 0.08] 1.7.2Patientswithoutdiabetes Heterogeneity:Chi 2 = 13.75, df= 3 (p= 0.003); I 2 =78% Test for overall effect:Z= 3.20 (p= 0.001) Total events 366 289 Subtotal (95%CI) 1952 16.1% 1956 0.04 [0.01, 0.06] BEST2015 45 304 34 325 2.6% 0.04 [–0.01, 0.10] EXCEL2016 94 722 107 742 6.0% –0.01 [–0.05, 0.02] FREEDOM 2012 188 698 118 658 5.6% 0.09 [0.05, 0.13] PRECOMBAT2011 39 228 30 231 1.9% 0.04 [–0.02, 0.11] 1.7.5Malegender Heterogeneity:Chi 2 = 6.69, df= 2 (p= 0.04); I 2 = 70% Test for overall effect:Z= 0.41 (p= 0.68) Total events 102 95 Subtotal (95%CI) 862 7.1% 846 0.01 [–0.02, 0.04] BEST2015 26 209 17 190 1.6% 0.03 [–0.03, 0.10] EXCEL2016 55 482 68 485 4.0% –0.03 [–0.07, 0.02] PRECOMBAT2011 21 171 10 171 1.4% 0.06 [0.00, 0.12] 1.7.4Nonelderly Heterogeneity:Chi 2 = 1.74, df= 2 (p= 0.42); I 2 = 0% Test for overall effect:Z= 1.91 (p= 0.06) Total events 138 127 Subtotal (95%CI) 824 7.2% 967 0.03 [–0.00, 0.07] BEST2015 41 229 30 252 2.0% 0.06 [–0.00, 0.12] EXCEL2016 82 466 67 463 3.8% 0.03 [–0.02, 0.08] PRECOMBAT2011 15 129 30 252 1.4% –0.00 [–0.07, 0.07] 1.7.3Elderly Stent Events Total Weight RiskDifference RiskDifference M-H,Fixed,95%CI CABG Events Total M-H,Fixed, 95%CI Figure 7 – Combined adverse events outcomes (major adverse cardiovascular and cerebrovascular disease events, MACCE) in subgroups in five studies. The size of each box is proportional to the number of patients in the subgroup. The bar is equal to the confidence interval. The diamonds represent the synthesis of the results. In the SYNTAX, FREEDOM, and EXCEL, the combined events were death, acute myocardial infarction (AMI), and stroke. In the remaining studies, they were death, AMI, and new revascularization. Abbreviations: CABG: coronary artery bypass grafting; SYNTAX: Synergy between PCI with Taxus and Cardiac Surgery; FREEDOM: Future Revascularization Evaluation in Patients with Diabetes Mellitus; 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. 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