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Comment & Response
June 2014

Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention in Multivessel Disease—Reply

Author Affiliations
  • 1Department of Cardiology, Acibadem University Medical School, Istanbul, Turkey
  • 2Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
JAMA Intern Med. 2014;174(6):1007-1008. doi:10.1001/jamainternmed.2014.762

In Reply Regarding our meta-analysis examining the effects of bypass grafting vs stenting in patients with multivessel coronary disease,1 Takagi et al challenge our results by stating that the included trials were heterogeneous because some of them used bare-metal stents (BMS) and others used drug-eluting stents (DES). I disagree. Bare-metal stents and DES are homogenous in the sense that they do not have different survival rates, which was the main outcome of interest in our meta-analysis. Moreover, our subgroup analyses presented in our article show that stents lead to higher mortality regardless of whether they are BMS or DES, with an interaction P value of .56 for the type of stent used. Takagi et al also suggest that DES and bypass have similar mortality rates, referring to an obsolete meta-analysis that did not include the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease) trial2 or the long-term follow-up of SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial,3 the only 2 major randomized trials comparing DES with coronary artery bypass graft (CABG) in this setting. Instead, this meta-analysis by Yan et al4 included 11 observational studies, the results of which contradict substantially with gold-standard evidence from randomized trials and therefore are misleading.

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