Evidence map›Paper›PMID 24958153›Full record

ArticleBMJ (Clinical research ed.)2014

Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis.

Stephan Windecker, Stefan Stortecky, Giulio G Stefanini, Bruno R da Costa, Bruno R daCosta, Anne Wilhelmina Rutjes, Marcello Di Nisio, Maria G Silletta, Maria G Siletta, Ausilia Maione and 25 more

Erratum issued Registry-linked trialOpen access · hybridAbstract readNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03507374 (PCSK9 Inhibition in Patients With Symptomatic Intracranial Atherosclerosis), which is not on this map. Cited by 106 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
106citing papers in PubMed, 13 pooled it
40.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03507374 early_phase1terminatedstarted 2018, after this paper: background citation

PCSK9 Inhibition in Patients With Symptomatic Intracranial Atherosclerosis

Ran2018Enrolled20Registered outcomes5Posted comparisons0ConditionsIntracranial Atherosclerosis, Intraplaque Hemorrhage, StrokeArmsAlirocumab, Placebo
PMID 25854637PMID 25790886PMID 25453443PMID 25307297PMID 25040677PMID 24741562PMID 24135208PMID 23988640PMID 23463579PMID 23404720PMID 22872053PMID 21958949other papers from this trial
Open the trial in the graph
3 · Its place in the literature

Who cites it

106 citing papers in PubMed, 13 syntheses or guidelines pooled it, 352 citations in OpenAlex.

  1. Drug Coated Balloons Versus Drug-Eluting Stents in Patients With De Novo Coronary Artery Disease.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025
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46 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

35 authors at 2 institutions in 2 countries.

Stephan Windecker
Stefan Stortecky
Giulio G Stefanini
Bruno R da Costa
Bruno R daCosta
Anne Wilhelmina Rutjes
Marcello Di Nisio
Maria G Silletta
Maria G Siletta
Ausilia Maione
Fernando Alfonso
Peter M Clemmensen
Jean-Philippe Collet
Jochen Cremer
Volkmar Falk
Gerasimos Filippatos
Christian Hamm
Stuart Head
Arie Pieter Kappetein
Adnan Kastrati
Juhani Knuuti
Ulf Landmesser
Günther Laufer
Franz-Joseph Neumann
Dimitri Richter
Patrick Schauerte
Miguel Sousa Uva
David P Taggart
Lucia Torracca
Marco Valgimigli
William Wijns
Adam Witkowski
Philippe Kolh
Peter Jüni
Peter Juni
University of Bern · CHUniversity of Liège · BE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease.

designBayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials while maintaining randomisation. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: A strategy of initial medical treatment compared with revascularisation by coronary artery bypass grafting or Food and Drug Administration approved techniques for percutaneous revascularization: balloon angioplasty, bare metal stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. DATA SOURCES: Medline and Embase from 1980 to 2013 for randomised trials comparing medical treatment with revascularisation.

main outcome measureAll cause mortality.

results100 trials in 93,553 patients with 262,090 patient years of follow-up were included. Coronary artery bypass grafting was associated with a survival benefit (rate ratio 0.80, 95% credibility interval 0.70 to 0.91) compared with medical treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment. Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a trend towards a reduced risk of myocardial infarction (0.75, 0.55 to 1.01). The risk of subsequent revascularisation was noticeably reduced by coronary artery bypass grafting (0.16, 0.13 to 0.20) followed by new generation drug eluting stents (zotarolimus (Resolute): 0.26, 0.17 to 0.40; everolimus: 0.27, 0.21 to 0.35), early generation drug eluting stents (zotarolimus (Endeavor): 0.37, 0.28 to 0.50; sirolimus: 0.29, 0.24 to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and bare metal stents (0.69, 0.59 to 0.81) compared with medical treatment.

conclusionAmong patients with stable coronary artery disease, coronary artery bypass grafting reduces the risk of death, myocardial infarction, and subsequent revascularisation compared with medical treatment. All stent based coronary revascularisation technologies reduce the need for revascularisation to a variable degree. Our results provide evidence for improved survival with new generation drug eluting stents but no other percutaneous revascularisation technology compared with medical treatment.

Indexed as

Coronary Artery DiseaseHumansMyocardial RevascularizationSurvival RateTreatment Outcome

Identifiers

PMID24958153
PMCPMC4066935
OpenAlexW2064409947

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.