Risk of stroke with percutaneous coronary intervention compared with on-pump and off-pump coronary artery bypass graft surgery: Evidence from a comprehensive network meta-analysis

Tullio Palmerini, Giuseppe Biondi-Zoccai, Diego Della Riva, Andrea Mariani, Carlo Savini, Marco Di Eusanio, Philippe Genereux, Giacomo Frati, Antonino G M Marullo, Giovanni Landoni, Teresa Greco, Angelo Branzi, Stefano De Servi, Germano Di Credico, Nevio Taglieri, Mathew R. Williams, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

Abstract

Background Although some trials have reported that on-pump coronary artery bypass graft (CABG) surgery may be associated with higher rates of stroke than percutaneous coronary intervention (PCI), whether stroke is more common after offpump CABG compared with PCI is unknown. We therefore sought to determine whether off-pump CABG is associated with an increased risk of stroke compared with PCI by means of network meta-analysis. Methods Randomized controlled trials (RCTs) comparing CABG vs PCI were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. Results Eighty-three RCTs with 22,729 patients randomized to on-pump CABG (n = 10,957), off-pump CABG (n = 7,119), or PCI (n = 4,653) were analyzed. Thirty-day rates of stroke were significantly lower in patients treated with PCI compared with either off-pump CABG (odds ratio [OR]; 0.39, 95% CI, 0.19-0.83) or on-pump CABG (OR, 0.26; 95% CI, 0.12-0.47). Compared with on-pump CABG, off-pump CABG was associated with significantly lower 30-day risk of stroke (OR, 0.67; 95% CI, 0.41-0.95). However, in sensitivity analyses restricted to high-quality studies, studies with more than either 100 or 1,000 patients, or studies with protocol definition or adjudication of stroke by a clinical events committee, the precision of the point estimate for the 30-day risk of stroke between off-pump vs on-pump CABG was markedly reduced. Conclusions Percutaneous coronary intervention is associated with lower 30-day rates of stroke than both off-pump and on-pump CABG. Further studies are required to determine whether the risk of stroke is reduced with off-pump CABG compared with on-pump CABG. (Am Heart J 2013;165:910-917.e14.).

Original languageEnglish
JournalAmerican Heart Journal
Volume165
Issue number6
DOIs
Publication statusPublished - Jun 2013

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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