Evidence map›Paper›PMID 27151532›Full record

ArticleCirculation2016

Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery.

Sripal Bangalore, Yu Guo, Zaza Samadashvili, Saul Blecker, Edward L Hannan

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed, 5 pooled it
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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

55 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Sripal BangaloreFrom New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.). sripalbangalore@gmail.com.
Yu GuoFrom New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).
Zaza SamadashviliFrom New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).
Saul BleckerFrom New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).
Edward L HannanFrom New York University School of Medicine (S. Bangalore, Y.G., S. Blecker); and School of Public Health, University at Albany, State University of New York at Albany (Z.S., E.L.H.).

Funding

Health Information Technology in Heart Failure CareK08HS023683 · AHRQ · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI BLECKER, SAUL B. · 2014 to 2017
$633k
AHRQ HHS K08 HS023683
6 · The paper itself

Abstract

backgroundGuidelines recommend coronary artery bypass graft surgery (CABG) over percutaneous coronary intervention (PCI) for multivessel disease and severe left ventricular systolic dysfunction. However, CABG has not been compared with PCI in such patients in randomized trials. METHODS AND

resultsPatients with multivessel disease and severe left ventricular systolic dysfunction (ejection fraction ≤35%) who underwent either PCI with everolimus-eluting stent or CABG were selected from the New York State registries. The primary outcome was long-term all-cause death. Secondary outcomes were individual outcomes of myocardial infarction, stroke, and repeat revascularization. Among the 4616 patients who fulfilled our inclusion criteria (1351 everolimus-eluting stent and 3265 CABG), propensity score matching identified 2126 patients with similar propensity scores. In the short term, PCI was associated with a lower risk of stroke (hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.01-0.39; P=0.004) in comparison with CABG. At long-term follow-up (median, 2.9 years), PCI was associated with a similar risk of death (HR, 1.01; 95% CI, 0.81-1.28; P=0.91), a higher risk of myocardial infarction (HR, 2.16; 95% CI, 1.42-3.28; P=0.0003), a lower risk of stroke (HR, 0.57; 95% CI, 0.33-0.97; P=0.04), and a higher risk of repeat revascularization (HR, 2.54; 95% CI, 1.88-3.44; P<0.0001). The test for interaction was significant (P=0.002) for completeness of revascularization, such that, in patients in whom complete revascularization was achieved with PCI, there was no difference in myocardial infarction between PCI and CABG.

conclusionsAmong patients with multivessel disease and severe left ventricular systolic dysfunction, PCI with everolimus-eluting stent had comparable long-term survival in comparison with CABG. PCI was associated with higher risk of myocardial infarction (in those with incomplete revascularization) and repeat revascularization, and CABG was associated with higher risk of stroke.

Indexed as

Drug-Eluting StentsSeverity of Illness IndexAgedAged, 80 and overCohort StudiesCoronary Artery BypassCoronary Artery DiseaseEverolimusFemaleFollow-Up StudiesHumansMaleMiddle AgedMyocardial RevascularizationSurvival RateTreatment OutcomeEverolimuscoronary artery bypasseverolimuspercutaneous coronary interventionventricular dysfunction

Identifiers

PMID27151532
PMCPMC6330114

What OpenQuestion holds

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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 OpenQuestion graph.