Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis
Pooled result · Cardiac deathResult — go to the resultRelative risk 0.79 95% CI 0.67–0.93Authors' conclusion
In stable coronary artery disease patients, randomisation to elective coronary revascularisation plus medical therapy led to reduced cardiac mortality compared with medical therapy alone. The cardiac survival benefit after revascularisation improved with longer follow-up times and was associated with fewer spontaneous MIs.
Study context
- Population
- Clinically stable CAD patients
- Participants
- 19,806 patients · 25 RCTs
- Comparison
- Revascularisation vs Medical therapy alone
- Revascularisationn = 10,023
- Medical therapy alonen = 9,783reference
- Outcome
- Cardiac mortality
- Follow-up
- Longest
Methodological detailsrandom-effects models, Databases searched from inception through November 2020
- Random-effects models
- Databases searched from inception through November 2020
Pooled result
Cardiac death
Relative risk
0.79
95% CI 0.67–0.93
P < 0.01
Revascularisation vs Medical therapy alone
RR 0.79 (95% CI 0.67–0.93); P < 0.01
As reported in the abstract
Further pooled results
| Outcome | Estimate | P value | |
|---|---|---|---|
| Spontaneous MI · longest follow-upRandom-effects model | RR 0.74 (95% CI 0.64–0.86) | P < 0.01 | |
| Cardiac death, meta-regression | RR per 4-year follow-up 0.81 (95% CI 0.69–0.96) | P = 0.008 | |
| 0.512Ratio (log scale) |
- Cardiac death, meta-regression — Cardiac death risk reduction linearly associated with spontaneous myocardial infarction (MI) absolute difference
- P = 0.01
- Cardiac death, meta-regression — Cardiac death risk reduction linearly associated with percentage of multivessel disease at baseline
- P = 0.004
All-cause mortality
- Did not differ significantly between strategies (RR 0.94, 95% CI 0.87-1.01)
- P = 0.11
Any MI
- Did not differ significantly between strategies
- P = 0.14
Stroke
- Did not differ significantly between strategies
- P = 0.30
Original publication
Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis. Eur Heart J. Published 18 May 2021. doi:10.
Summarised from the published abstract; every number is checked against it