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Editor's Correspondence
July 9, 2012

Stenting vs Medical Therapy for Stable Coronary Artery Disease: A Minefield for Meta-analyses?

Author Affiliations

Author Affiliations: Cardiovascular, Respiratory, Geriatric, and Nephrologic Sciences Department, Umberto I Hospital (Drs Sardella and Fedele), and Department of Medico-Surgical Sciences and Biotechnologies (Dr Biondi-Zoccai), Sapienza University of Rome, Rome, Italy.

Arch Intern Med. 2012;172(13):1044-1045. doi:10.1001/archinternmed.2012.1874

We read with interest the meta-analysis by Stergiopoulos and Brown1 comparing stenting vs medical therapy for stable coronary artery disease (CAD). However, we believe that the review methodology is flawed, and thus the implications are potentially wrong.

First, the study search was limited to MEDLINE/PubMed, which has very limited coverage and comprehensiveness. The incomplete scope of the search strategy greatly increases the likelihood that publication bias and selective reporting undermine the meta-analysis.2 At a minimum, The Cochrane Collaboration CENTRAL Registry of Randomized Trials, EMBASE, and key international conference proceedings (eg, America College of Cardiology and American Heart Association scientific sessions) should have been systematically queried. Thus, we recommend that the authors perform additional and more thorough searches for potentially eligible studies.

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