Background
Methods
Data sources and search strategy
Inclusion and exclusion criteria
Types of participants
Outcomes and definitions
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Adverse clinical outcomes such as all-cause mortality, stroke, MACCEs, Myocardial infarction (MI) and repeated or further revascularization during a long-term follow-up period (≥1 year) were considered as the clinical endpoints in this study. Reported clinical outcomes and follow up periods have been represented in Table 1.Table 1Reported outcomes and follow up periodsStudiesFollow-up (years)Clinical outcomesBanning [8]1Death, MI, stent thrombosis, repeated revascularization, MACCEsBari [9]5DeathDangas [2]1, 5Death, stroke, MI, repeated revascularization, MACCEsDetre [10]5DeathFarkouh [11]1, 2, 5Death, MACCEs, MI, stroke, repeated revascularizationKamalesh [12]1, 2Death, stroke, MI, repeated revascularizationKappetein [13]5Death, stroke, MI, repeated revascularization, stent thrombosisKapur [4]1Death, non-fatal MI, stroke, further revascularization, MACCEsLima [14]10DeathSoares [15]1, 2–5Death
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MACCEs included all-cause death, cerebrovascular accident (CVA), MI or repeat revascularization (subsequent to PCI or CABG).
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Stroke was defined as focal neurological deficits of central origin lasting >72 h, resulting in permanent brain damage or body impairment.
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Death was defined as all-cause death. If data for all cause death was not available, data for cardiac death have been used.
Data extraction and quality assessment
Statistical analysis
Ethics
Results
Study selection and general features of the included studies
Studies | Trial name | Study type | Region | Randomization period (year) | Patients in CABG group (n) | Patients in PCI group (n) |
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Banning (2010) | SYNTAX | RCT | England | – | 88 | 88 |
Bari (1997) | BARI | RCT | Pittsburgh | 1988–1991 | 47 | 45 |
Dangas (2014) | FREEDOM | RCT | New York | 2005–2010 | 277 | 325 |
Detre (1999) | BARI | RCT | Pittsburgh | 1988–1991 | 80 | 78 |
Farkouh (2012) | FREEDOM | RCT | New York | 2005–2010 | 293 | 322 |
Kamalesh (2013) | – | RCT | Indiana | 2006–2010 | 45 | 48 |
Kappetein (2013) | SYNTAX | RCT | Netherlands | – | 93 | 89 |
Kapur (2010) | CARDIa | RCT | England | – | 99 | 88 |
Lima (2013) | MASS II | RCT | Brazil | 1995–2000 | 29 | 30 |
Soares (2006) | MASS II | RCT | Brazil | 1995–2000 | 23 | 19 |
Baseline characteristics
Trials | Age (years) | Males (%) | HT (%) | Cs (%) | Cochrane |
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CABG/PCI | CABG/PCI | CABG/PCI | CABG/PCI | Bias score | |
Banning [8] | 65.4/65.4 | 71.0/71.0 | 69.9/69.9 | 15.8/15.8 | 8 |
Bari (1997) | 62.5/62.1 | 58.0/56.0 | 66.0/65.0 | – | 9 |
Dangas [2] | 62.6/62.6 | 61.3/6.3 | 87.5/87.5 | 17.9/17.9 | 8 |
Detre [10] | 62.3/62.3 | 57.0/57.0 | 65.0/65.0 | 65.0/65.0 | 9 |
Farkouh [11] | 63.1/63.2 | 69.5/73.2 | – | 16.6/14.8 | 8 |
Kamalesh [12] | 62.1/62.7 | 99.0/99.0 | 95.7/96.0 | 20.6/27.7 | 8 |
Kappetein [13] | 65.4/65.4 | 71.0/71.0 | 70.0/70.0 | 16.0/16.0 | 8 |
Kapur [4] | 63.6/64.3 | 77.9/70.7 | 76.6/76.6 | 24.6/24.6 | 10 |
Lima [14] | 59.0/61.0 | 72.0/56.0 | 71.0/72.0 | 34.0/17.0 | 8 |
Soares [15] | 60.0/61.0 | 67.0/54.0 | 73.0/73.0 | – | 8 |
Results of this meta-analysis
Long-term outcomes | Trials analyzed | OR, 95 % CI | P value | I2 % |
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Mortality | 6 | 0.59 [0.42, 0.85] | 0.004 | 4 |
MI | 4 | 0.75 [0.46, 1.20] | 0.23 | 26 |
MACCEs | 3 | 0.51 [0.27, 0.99] | 0.03 | 72 |
Stroke | 4 | 1.41 [0.64, 3.09] | 0.40 | 0 |
Revascularization | 5 | 0.34 [0.24, 0.49] | <0.00001 | 38 |
Mortality at 1 year | 5 | 1.07 [0.52, 2.19] | 0.86 | 0 |
Mortality during 5 years | 4 | 0.56 [0.40, 0.79] | 0.001 | 0 |