Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella review
Background: Invasive management of stable coronary artery disease is still a controversial topic. The purpose of this umbrella review was to synthesize systematic reviews (SRs) that evaluate the benefits and harms of percutaneous coronary intervention (PCI) versus optimal medical therapy (OMT) in pa...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024032419 |
| _version_ | 1797259703523213312 |
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| author | David R. Soriano-Moreno Daniel Fernandez-Guzman Kimberly G. Tuco Anderson N. Soriano-Moreno Fabricio Ccami-Bernal Abdiel H. Coico-Lama Antony G. Gonzáles-Uribe Alvaro Taype-Rondan |
| author_facet | David R. Soriano-Moreno Daniel Fernandez-Guzman Kimberly G. Tuco Anderson N. Soriano-Moreno Fabricio Ccami-Bernal Abdiel H. Coico-Lama Antony G. Gonzáles-Uribe Alvaro Taype-Rondan |
| author_sort | David R. Soriano-Moreno |
| collection | DOAJ |
| description | Background: Invasive management of stable coronary artery disease is still a controversial topic. The purpose of this umbrella review was to synthesize systematic reviews (SRs) that evaluate the benefits and harms of percutaneous coronary intervention (PCI) versus optimal medical therapy (OMT) in patients with stable coronary artery disease. Methods: We systematically searched PubMed/MEDLINE, Embase, and CENTRAL from 2018 to August 7, 2022. We included SRs with meta-analyses of randomized controlled trials (RCTs) that evaluated the question of interest. We assessed the methodological quality of the SRs with the AMSTAR-2 tool. We summarized the results of the outcomes for each SR. We calculated the degree of overlap of the RCTs included in the SRs using the corrected covered area (CCA). Results: We found 10 SRs with meta-analyses. The SRs included 3 to 15 RCTs. The degree of overlap among the SRs was very high (CCA > 15%). No SR evaluated the certainty of the evidence using the GRADE system and 9 out of 10 had critically low methodological quality. The SRs reported heterogeneous results for the outcomes of all-cause mortality, myocardial infarction, revascularization, and angina. On the other hand, for the outcomes of cardiovascular mortality and stroke, all SRs agreed that there were no differences between PCI and OMT alone. Conclusions: We found 10 SRs on the use of PCI compared to OMT alone for patients with stable coronary artery disease. However, none had high methodological quality, none evaluated the certainty of the evidence using the GRADE approach, and the results were inconsistent for several outcomes. This variability in evidence may result in divergent clinical decisions for the management of stable coronary artery disease among healthcare professionals. It is necessary to perform a high-quality SR using the GRADE approach to clarify the balance of benefits and harms of PCI. |
| first_indexed | 2024-04-24T23:13:39Z |
| format | Article |
| id | doaj.art-533ddde2d4e04f8880b0a6a136ebd504 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-04-24T23:13:39Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-533ddde2d4e04f8880b0a6a136ebd5042024-03-17T07:57:39ZengElsevierHeliyon2405-84402024-03-01105e27210Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella reviewDavid R. Soriano-Moreno0Daniel Fernandez-Guzman1Kimberly G. Tuco2Anderson N. Soriano-Moreno3Fabricio Ccami-Bernal4Abdiel H. Coico-Lama5Antony G. Gonzáles-Uribe6Alvaro Taype-Rondan7Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru; Corresponding author.Carrera de Medicina Humana, Universidad Científica del Sur, Lima, PeruUnidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, PeruUnidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, PeruFacultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, PeruUnidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, PeruUnidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, PeruUnidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru; EviSalud – Evidencias en Salud, Lima, PeruBackground: Invasive management of stable coronary artery disease is still a controversial topic. The purpose of this umbrella review was to synthesize systematic reviews (SRs) that evaluate the benefits and harms of percutaneous coronary intervention (PCI) versus optimal medical therapy (OMT) in patients with stable coronary artery disease. Methods: We systematically searched PubMed/MEDLINE, Embase, and CENTRAL from 2018 to August 7, 2022. We included SRs with meta-analyses of randomized controlled trials (RCTs) that evaluated the question of interest. We assessed the methodological quality of the SRs with the AMSTAR-2 tool. We summarized the results of the outcomes for each SR. We calculated the degree of overlap of the RCTs included in the SRs using the corrected covered area (CCA). Results: We found 10 SRs with meta-analyses. The SRs included 3 to 15 RCTs. The degree of overlap among the SRs was very high (CCA > 15%). No SR evaluated the certainty of the evidence using the GRADE system and 9 out of 10 had critically low methodological quality. The SRs reported heterogeneous results for the outcomes of all-cause mortality, myocardial infarction, revascularization, and angina. On the other hand, for the outcomes of cardiovascular mortality and stroke, all SRs agreed that there were no differences between PCI and OMT alone. Conclusions: We found 10 SRs on the use of PCI compared to OMT alone for patients with stable coronary artery disease. However, none had high methodological quality, none evaluated the certainty of the evidence using the GRADE approach, and the results were inconsistent for several outcomes. This variability in evidence may result in divergent clinical decisions for the management of stable coronary artery disease among healthcare professionals. It is necessary to perform a high-quality SR using the GRADE approach to clarify the balance of benefits and harms of PCI.http://www.sciencedirect.com/science/article/pii/S2405844024032419Percutaneous coronary interventionOptimal medical treatmentStable Angina |
| spellingShingle | David R. Soriano-Moreno Daniel Fernandez-Guzman Kimberly G. Tuco Anderson N. Soriano-Moreno Fabricio Ccami-Bernal Abdiel H. Coico-Lama Antony G. Gonzáles-Uribe Alvaro Taype-Rondan Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella review Heliyon Percutaneous coronary intervention Optimal medical treatment Stable Angina |
| title | Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella review |
| title_full | Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella review |
| title_fullStr | Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella review |
| title_full_unstemmed | Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella review |
| title_short | Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella review |
| title_sort | percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease an umbrella review |
| topic | Percutaneous coronary intervention Optimal medical treatment Stable Angina |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024032419 |
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