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Evidence for Use of Coronary Stents: A Hierarchical Bayesian Meta-Analysis

James M. Brophy, MD, PhD; Patrick Belisle, MSc; and Lawrence Joseph, PhD
[+] Article and Author Information

From McGill University, Montreal, Quebec, Canada.


Grant Support: Dr. Brophy was supported by Les Fonds de la Recherche en Santé du Québec and Dr. Joseph by the Canadian Institutes of Health Research.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: James Brophy, MD, PhD, Division of Epidemiology, McGill University Health Center (MUHC), Royal Victoria Hospital, 687 Pine Avenue West, Room 4.12, Montreal, Quebec H3A 1A1, Canada; e-mail, james.brophy@mcgill.ca.

Current Author Addresses: Dr. Brophy: Division of Epidemiology, McGill University Health Center (MUHC), Royal Victoria Hospital, 687 Pine Avenue West, Room 4.12, Montreal, Quebec H3A 1A1, Canada.

Mr. Belisle and Dr. Joseph: Division of Clinical Epidemiology, Montreal General Hospital, McGill University, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada.

Author Contributions: Conception and design: J.M. Brophy, L. Joseph.

Analysis and interpretation of the data: J.M. Brophy, P. Belisle, L. Joseph.

Drafting of the article: J.M. Brophy, L. Joseph.

Critical revision of the article for important intellectual content: J.M. Brophy, P. Belisle, L. Joseph.

Final approval of the article: J.M. Brophy, P. Belisle, L. Joseph.

Statistical expertise: J.M. Brophy, P. Belisle, L. Joseph.

Obtaining of funding: J.M. Brophy.

Administrative, technical, or logistic support: J.M. Brophy

Collection and assembly of the data: J.M. Brophy, L. Joseph.


Ann Intern Med. 2003;138(10):777-786. doi:10.7326/0003-4819-138-10-200305200-00005
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The search protocol identified 29 randomized studies involving 9918 patients that compared standard PTCA to routine coronary stenting (Appendix Table). The studies examined patients with stable and unstable angina (Table 1) as well as various types of lesions: 15 studies in large native vessels (>3 mm), 5 studies in small native vessels (<3 mm), 7 studies of occluded vessels, and 1 study each of restenosed native arteries and bypass grafts. In addition, rates of crossover were studied (Table 2).

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Figures

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Figure 1.
Forest plot comparing the rate of death or myocardial infarction in the elective stenting and standard percutaneous transluminal coronary angioplasty (PTCA) groups for the 29 trials.

Values in the second and third columns are number of patients sustaining outcome of interest/number of patients in treatment group.

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Figure 2.
Forest plot comparing the rate of angiographic restenosis in the elective stenting and standard percutaneous transluminal coronary angioplasty (PTCA) groups for the 25 trials with an angiographic follow-up end point.

Values in the second and third columns are number of patients sustaining outcome of interest/number of patients in treatment group.

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Figure 3.
Forest plot comparing the rate of repeated percutaneous transluminal coronary angioplasty (PTCA) in the elective stenting and standard PTCA groups for the 29 trials.

Values in the second and third columns are number of patients sustaining outcome of interest/number of patients in treatment group.

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Figure 4.
Plot of the difference between the elective stenting and standard percutaneous transluminal coronary angioplasty (PTCA) groups for the outcome of repeated PTCA as a function of the stent crossover rate in the standard PTCA groups.
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Summary for Patients

Benefits of Coronary Stents

The summary below is from the full report titled “Evidence for Use of Coronary Stents. A Hierarchical Bayesian Meta-Analysis.” It is in the 20 May 2003 issue of Annals of Internal Medicine (volume 138, pages 777-786). The authors are J.M. Brophy, P. Belisle, and L. Joseph.

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