Evidence map›Paper›PMID 33742721›Full record

SynthesisClinical cardiology2021

Invasive therapy versus conservative therapy for patients with stable coronary artery disease: An updated meta-analysis.

Aviral Vij, Kameel Kassab, Hitesh Chawla, Amandeep Kaur, Vamsi Kodumuri, Neeraj Jolly, Rami Doukky

Open access · goldAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 3 pooled it
5.0field-weighted citation impact, top 4% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 28 citations in OpenAlex.

  1. Pooled it
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  15. Three Technologies That Will Guide Revascularization of Chronic Coronary Syndrome Patients into the 21st Century: A Review.The International journal of angiology : official publication of the International College of Angiology, Inc · 2021
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 5 institutions in 2 countries.

Aviral VijDivision of Cardiology, Cook County Health, Chicago, Illinois, USA.
Kameel KassabDivision of Cardiology, Cook County Health, Chicago, Illinois, USA.ORCID https://orcid.org/0000-0002-4878-4663
Hitesh ChawlaDivision of Cardiology, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.
Amandeep KaurDepartment of Pathology, University of Chicago-Northshore, Evanston, Illinois, USA.
Vamsi KodumuriDivision of Cardiology, Ascension All Saints Hospital, Racine, Wisconsin, USA.
Neeraj JollyDivision of Cardiology, Rush University Medical Center, Chicago, Illinois, USA.
Rami DoukkyDivision of Cardiology, Cook County Health, Chicago, Illinois, USA.ORCID https://orcid.org/0000-0001-9767-9344
Rush University Medical Center · USAll Saints Hospital · ZACook County Health and Hospitals System · USMedStar Union Memorial Hospital · USNorthShore University HealthSystem · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHeart disease remains the leading cause of death in the United States. Although there are clear indications for revascularization in patients with acute coronary syndromes, there is debate regarding the benefits of revascularization in stable ischemic heart disease. We sought to perform a comprehensive meta-analysis to assess the role of revascularization compared to conservative medical therapy alone in patients with stable ischemic heart disease. HYPOTHESIS: There is no significant difference in all-cause mortality or cardiovascular mortality between invasive and medical arms.

methodsWe performed a systematic literature search from January 2000 to June 2020. Our literature search yielded seven randomized controlled trials. We analyzed a total of 12 013 patients (6109 in revascularization arm and 5904 in conservative medical therapy arm). Primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac events (MACE) (death, myocardial infarction [MI], or stroke), cardiovascular mortality, MI, and stroke. Additional subgroup analysis for all-cause mortality was performed comparing percutaneous coronary intervention (PCI) with bare metal stent versus conservative therapy; and PCI with drug eluting stent versus conservative therapy.

resultsThere was no statistically significant difference in primary outcome of all-cause mortality between either arm (odds ratio [OR] = 0.95; 95% CI [confidence interval], 0.83 to 1.08; p = .84). There were statistically significant lower rates of MACE (death, MI or stroke) in the revascularization arm when compared to conservative arm.

conclusionsOur analysis did not show any survival advantage of an initial invasive strategy over conservative medical therapy in patients with stable coronary artery disease (CAD).

Indexed as

Conservative TreatmentCoronary Artery DiseaseDrug-Eluting StentsPercutaneous Coronary InterventionAgedAged, 80 and overFemaleHumansMaleRisk AssessmentRisk FactorsTreatment Outcomecoronary artery bypass graftingmedical therapypercutaneous coronary interventionstable coronary artery disease

Identifiers

PMID33742721
PMCPMC8119834
OpenAlexW3137359886

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.