Analysis confirms guidelines on PCI versus CABG

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1. Bayesian analysis of randomized controlled trials and cohort studies of patients with unprotected left main coronary artery disease (ULMCAD) supports current guidelines. 

2. Percutaneous intervention (PCI) and coronary artery bypass graft (CABG) were found to be comparable treatments for ULMCAD and medical therapy only was associated with higher 1-year mortality. 

Evidence Rating Level: 2 (Good) 

Study Rundown: A Bayesian cross-design and network meta-analysis arrived at the same conclusions as most approaches in its constituent studies regarding management of patients with unprotected left main coronary artery disease (ULMCAD). With slightly wider credible interval, the Bayesian analysis concluded that PCI and CABG are comparable treatments for this patient population, and that medical therapy is inferior.

Click to read the study in Circulation

Click to read an accompanying editorial in Circulation

Relevant Reading: Bayesian perspectives for epidemiological research: Foundations and basic methods 

In-Depth: 19 studies, 12 comparing PCI versus CABG and 7 comparing CABG versus medical therapy, were weighted according to Bayesian methods that distinguished randomized controlled trials and cohort studies. A separate analysis also distinguished older studies in the analysis by assigning them less weight. The 95% Bayesian credible interval comparing PCI versus CABG 1 year mortality from the cross-design meta-analysis was 0.68 to 1.45 with an OR of 1.01, suggesting no significant difference. These findings were similar to results of frequentist approaches, both by fixed-effect and random-effects.

By Gina Siddiqui and Allen Ho

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