SynthesisEuropean heart journal2021
Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis.
Synthesis in European heart journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 2 of them syntheses that pooled 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.
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.
Who cites it
61 citing papers in PubMed, 2 syntheses or guidelines pooled it, 147 citations in OpenAlex.
- [Guidelines of the European Society of Cardiology on chronic coronary syndrome from 2024].Herz · 2025Guideline
- Official Scientific Statement from the Brazilian Society of Cardiovascular Surgery - The 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization and the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for Chronic Coronary Disease.Brazilian journal of cardiovascular surgery · 2024Guideline
- Obstructive Coronary Artery Disease and Health Status in Transcatheter Aortic Valve Replacement: A Post Hoc Analysis of the SCOPE I Randomized Clinical Trial.JAMA network open · 2025Trial
- Clinical risk prediction, coronary computed tomography angiography, and cardiovascular events in new-onset chest pain: the PROMISE and SCOT-HEART trials.European heart journal · 2025Trial
- Outcomes with revascularisation versus conservative management of participants with 3-vessel coronary artery disease in the ISCHEMIA trial.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2024Trial
- Variation in Health Status With Invasive vs Conservative Management of Chronic Coronary Disease.Journal of the American College of Cardiology · 2024Trial
- Impact of residual angina on long-term clinical outcomes after percutaneous coronary intervention or coronary artery bypass graft for complex coronary artery disease.European heart journal. Quality of care & clinical outcomes · 2023Trial
- Revascularisation, periprocedural events and survival - and the survival of the randomised controlled trial.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2023Trial
- Trial
- Evolocumab for prevention of microvascular dysfunction in patients undergoing percutaneous coronary intervention: the randomised, open-label EVOCATION trial.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2022Trial
- Korean Society of Interventional Cardiology Expert Consensus for the Management of Chronic Coronary Syndrome: Part 2.Korean circulation journal · 2026Review
- Anatomy Meets Evidence: Left Main Bifurcation Stenting in the Era of Network Meta-analysis.Journal of the Society for Cardiovascular Angiography & Interventions · 2026Article
- Article
- [β‑blockers after percutaneous coronary intervention does not reduce risks of all-cause mortality or major adverse cardiovascular events in patients with stable coronary artery disease].Nan fang yi ke da xue xue bao = Journal of Southern Medical University · 2026Article
- Percutaneous coronary intervention plus guideline-directed medical therapy (GDMT) versus GDMT alone in adults with stable coronary artery disease.The Cochrane database of systematic reviews · 2026Article
- Long-acting nitrate use before and after revascularization to evaluate angina in chronic coronary syndrome: a case-crossover study from SCAAR.The Lancet regional health. Europe · 2026Article
- Observational
- Coronary Artery Bypass Grafting: A Review of Short- and Long-Term Outcomes.The International journal of angiology : official publication of the International College of Angiology, Inc · 2025Review
- Revascularization in Stable Coronary Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.The International journal of angiology : official publication of the International College of Angiology, Inc · 2025Review
- Guideline for Chronic Coronary Syndrome - 2025.Arquivos brasileiros de cardiologia · 2025Article
1 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
18 authors at 16 institutions in 8 countries.
Funding
Abstract
aimsThe value of elective coronary revascularisation plus medical therapy over medical therapy alone in managing stable patients with coronary artery disease is debated. We reviewed all trials comparing the two strategies in this population. METHODS AND
resultsFrom inception through November 2020, MEDLINE, EMBASE, Google Scholar, and other databases were searched for randomised trials comparing revascularisation against medical therapy alone in clinically stable coronary artery disease patients. Treatment effects were measured by rate ratios (RRs) with 95% confidence intervals, using random-effects models. Cardiac mortality was the pre-specified primary endpoint. Spontaneous myocardial infarction (MI) and its association with cardiac mortality were secondary endpoints. Further endpoints included all-cause mortality, any MI, and stroke. Longest follow-up data were abstracted. The study is registered with PROSPERO (CRD42021225598). Twenty-five trials involving 19 806 patients (10 023 randomised to revascularisation plus medical therapy and 9783 to medical therapy alone) were included. Compared with medical therapy alone, revascularisation yielded a lower risk of cardiac death [RR 0.79 (0.67-0.93), P < 0.01] and spontaneous MI [RR 0.74 (0.64-0.86), P < 0.01]. By meta-regression, the cardiac death risk reduction after revascularisation, compared with medical therapy alone, was linearly associated with follow-up duration [RR per 4-year follow-up: 0.81 (0.69-0.96), P = 0.008], spontaneous MI absolute difference (P = 0.01) and percentage of multivessel disease at baseline (P = 0.004). Trial sequential and sensitivity analyses confirmed the reliability of the cardiac mortality findings. All-cause mortality [0.94 (0.87-1.01), P = 0.11], any MI (P = 0.14), and stroke risk (P = 0.30) did not differ significantly between strategies.
conclusionIn stable coronary artery disease patients, randomisation to elective coronary revascularisation plus medical therapy led to reduced cardiac mortality compared with medical therapy alone. The cardiac survival benefit after revascularisation improved with longer follow-up times and was associated with fewer spontaneous MIs.
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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 OpenQuestion graph.