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Evidence summaries

Coronary Artery Stenting Compared with Ptca Alone

There appears to be a reduced risk of the need for repeat PTCA and target vessel revascularization, and probably of cardiovascular events, with coronary artery stents compared to PTCA alone. Level of evidence: "B"

A systematic review 1 including 5 studies with a total of 1 247 subjects was abstracted in DARE. Four of five RCTs found that stenting leads to significantly reduced angiographic restenosis rate. In four studies that reported the number of clinically significant events two studies reported no events in either group, and the two remaining studies found that stenting leads to a reduction in events. One study found a significantly reduced requirement for revascularization with stenting, and one study found no difference. The largest and longest series evaluated 175 patients who were followed for five years. The restenosis rate was 26%, with late restenosis in 2% of patients.

Another systematic review 2 including 11 RCTs with a total of 2 718 subjects was abstracted in DARE. The OR for risk of death was 0.71 (95% CI 0.38 to 1.31), for risk of CABG 0.95 (95% CI 0.65 to 1.40), for repeat PTCA 0.57 (95% CI 0.47 to 0.70), for target vessel revascularization 0.48 (95% CI 0.37 to 0.63).

Comment: The quality of evidence is downgraded by indirectness of evidence (short follow-up period, inconclusive data for clinical outcomes other than restenosis)

    References

    • The Wessex Institute for Health Research and Development. Stents for coronary artery disease (CAD). Development and Evaluation Committee Report 1998;87:1-33. [DARE]
    • Meads C, Cummings C, Stevens A. Coronary artery stents. West Midlands Development and Evaluation Committee Report. 9. 1998:1-76. [DARE]

Primary/Secondary Keywords