Coronary disease & ACS

Effects of Elective Coronary Revascularization vs Medical Therapy Alone on Noncardiac Mortality: A Meta-Analysis

JACC Cardiovasc IntervPublished Systematic review and meta-analysis of randomised trials

Authors' conclusion

In patients with CCS, noncardiac mortality in late follow-up was similar for revascularization plus MT compared with MT alone.

Study context

Population
Patients with chronic coronary syndrome (CCS)
Participants
16,908 patients18 RCTs
Comparison
Revascularization plus medical therapy (MT) vs MT alone
  • Revascularization plus MTn = 8,665
  • MT alonen = 8,243reference
Outcome
Noncardiac mortality
Follow-up
Longest
Methodological detailsrandom-effects models, trial sequential analysis, Bayesian meta-analysis, meta-regression
  • Random-effects models
  • Trial sequential analysis
  • Bayesian meta-analysis
  • Meta-regression

Pooled result

As reported in the abstract

No significant difference in noncardiac mortality between the assigned treatment groups (RR, 95% CI)

RR: 1.09; 95% CI: 0.94-1.26

P = 0.26

Further pooled results

OutcomeP value
Effect of follow-up duration on noncardiac death rates (meta-regression)Follow-up duration did not affect noncardiac death ratesP = 0.52

Noncardiac mortality, excluding the ISCHEMIA trial

Results consistent without the ISCHEMIA trial (RR, 95% CI)
RR: 1.00; 95% CI: 0.84-1.18; P = 0.97

Trial sequential analysis

Cumulative Z-curve within the nonsignificance area, reaching futility boundaries

Noncardiac mortality, Bayesian meta-analysis

Consistent with the standard approach (RR, 95% CrI)
RR: 1.08; 95% credible interval: 0.90-1.31

Original publication

Effects of Elective Coronary Revascularization vs Medical Therapy Alone on Noncardiac Mortality: A Meta-Analysis. JACC Cardiovasc Interv. Published 22 May 2023. doi:10.1016/j.jcin.2023.02.030

Composed by AI from the published abstract and checked against it. How Briefs are made →

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