{"id":300,"date":"2018-02-23T16:27:11","date_gmt":"2018-02-23T16:27:11","guid":{"rendered":"http:\/\/centroceci.com.ar\/web\/?p=300"},"modified":"2018-03-08T16:27:08","modified_gmt":"2018-03-08T16:27:08","slug":"primer-metaanalisis-sobre-mortalidad-entre-cabg-y-stents-arroja-como-favorable-a-la-cirugia","status":"publish","type":"post","link":"http:\/\/centroceci.com.ar\/web\/2018\/02\/23\/primer-metaanalisis-sobre-mortalidad-entre-cabg-y-stents-arroja-como-favorable-a-la-cirugia\/","title":{"rendered":"Primer metaan\u00e1lisis sobre mortalidad entre CABG y Stents arroja como favorable a la Cirug\u00eda"},"content":{"rendered":"

La revista The Lancet<\/a> public\u00f3 un extenso metaan\u00e1lisis de 11 estudios randomizados entre stents(bare metal o farmacol\u00f3gicos) y cirug\u00eda de revascularizaci\u00f3n mioc\u00e1rdica, para pacientes con enfermedad de m\u00faltiples vasos y tronco no protegido de CI. Se bas\u00f3 en la base de datos individuales de todos esos estudios randomizados.<\/p>\n

La conclusi\u00f3n es que los pacientes tratados con cirug\u00eda tienen una significativa mejor sobrevida que los tratados con stents, en relaci\u00f3n con la complejidad de las lesiones y la presencia de diabetes. No hubo interacci\u00f3n entre el uso de stents convencionales o farmacol\u00f3gicos.<\/p>\n

Los resultados de este importante estudio sobre m\u00e9todos de revascularizaci\u00f3n en enfermedad coronaria, el primero que analiza mortalidad, ser\u00e1 motivo seguramente de mucha discusi\u00f3n y an\u00e1lisis de subgrupos.<\/p>\n

Summary<\/strong>
\nBackground<\/em>
\nNumerous randomised trials have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies.<\/p>\n

Methods<\/em>
\nWe did a systematic review up to July 19, 2017, to identify randomised clinical trials comparing CABG with PCI using stents. Eligible studies included patients with multivessel or left main coronary artery disease who did not present with acute myocardial infarction, did PCI with stents (bare-metal or drug-eluting), and had more than 1 year of follow-up for all-cause mortality. In a collaborative, pooled analysis of individual patient data from the identified trials, we estimated all-cause mortality up to 5 years using Kaplan-Meier analyses and compared PCI with CABG using a random-effects Cox proportional-hazards model stratified by trial. Consistency of treatment effect was explored in subgroup analyses, with subgroups defined according to baseline clinical and anatomical characteristics.<\/p>\n

Findings<\/em>
\nWe included 11 randomised trials involving 11\u2008518 patients selected by heart teams who were assigned to PCI (n=5753) or to CABG (n=5765). 976 patients died over a mean follow-up of 3\u00b78 years (SD 1\u00b74). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score was 26\u00b70 (SD 9\u00b75), with 1798 (22\u00b71%) of 8138 patients having a SYNTAX score of 33 or higher. 5 year all-cause mortality was 11\u00b72% after PCI and 9\u00b72% after CABG (hazard ratio [HR] 1\u00b720, 95% CI 1\u00b706\u20131\u00b737; p=0\u00b70038). 5 year all-cause mortality was significantly different between the interventions in patients with multivessel disease (11\u00b75% after PCI vs 8\u00b79% after CABG; HR 1\u00b728, 95% CI 1\u00b709\u20131\u00b749; p=0\u00b70019), including in those with diabetes (15\u00b75% vs 10\u00b70%; 1\u00b748, 1\u00b719\u20131\u00b784; p=0\u00b70004), but not in those without diabetes (8\u00b77% vs 8\u00b70%; 1\u00b708, 0\u00b786\u20131\u00b736; p=0\u00b749). SYNTAX score had a significant effect on the difference between the interventions in multivessel disease. 5 year all-cause mortality was similar between the interventions in patients with left main disease (10\u00b77% after PCI vs 10\u00b75% after CABG; 1\u00b707, 0\u00b787\u20131\u00b733; p=0\u00b752), regardless of diabetes status and SYNTAX score.<\/p>\n

Interpretation<\/em>
\nCABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. No benefit for CABG over PCI was seen in patients with left main disease. Longer follow-up is needed to better define mortality differences between the revascularisation strategies.<\/p>\n

Funding<\/em>
\nNone.<\/p>\n

http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)30423-9\/fulltext<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

La revista The Lancet public\u00f3 un extenso metaan\u00e1lisis de 11 estudios randomizados entre stents(bare metal o farmacol\u00f3gicos) y cirug\u00eda de revascularizaci\u00f3n mioc\u00e1rdica, para pacientes con enfermedad de m\u00faltiples vasos y tronco no protegido de CI. Se bas\u00f3 en la base de datos individuales de todos esos estudios randomizados. La conclusi\u00f3n es que los pacientes tratados …<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,7],"tags":[12,9,14],"_links":{"self":[{"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/posts\/300"}],"collection":[{"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/comments?post=300"}],"version-history":[{"count":3,"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/posts\/300\/revisions"}],"predecessor-version":[{"id":316,"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/posts\/300\/revisions\/316"}],"wp:attachment":[{"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/media?parent=300"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/categories?post=300"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/centroceci.com.ar\/web\/wp-json\/wp\/v2\/tags?post=300"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}