Comparison between primary angioplasty and stent placement for symptomatic XXXX : meta-analysis of case series.

@entity1 @entity64 @entity256 @entity4522
OBJECTIVE: To compare the short- and long-term rates of @entity64 associated with primary angioplasty alone and angioplasty with stent placement using a meta-analysis of published studies. Both primary angioplasty alone and angioplasty with stent placement have been proposed as treatment strategies for symptomatic @entity4522 to reduce the risk of @entity64 with best medical treatment alone. However, it remains unclear which of these endovascular techniques offers the best risk reduction. METHODS: We identified pertinent studies published between January 1980 and May 2008 using a search on PubMed and Cochrane libraries, supplemented by a review of bibliographies of selected publications. The incidences of @entity64 were estimated for each report and pooled for both angioplasty alone and angioplasty with stent placement at 1 month and 1 year postintervention and then compared using a random-effects model. The association of year of publication and 1-year incidence of @entity64 was analyzed with meta-regression. RESULTS: After applying our selection criteria, we included 69 studies (33 primary angioplasty-alone studies [1027 @entity1 ] and 36 studies of angioplasty with stent placement [1291 @entity1 ]) in the analysis. There were a total of 91 @entity64 reported in the angioplasty-alone-treated group (8.9%; 95% confidence interval [CI], 7.1%-10.6%), compared with 104 @entity64 in the angioplasty-with-stent-treated group (8.1%; 95% CI, 6.6%-9.5%) during a 1-month period (relative risk [RR], 1.1; P = 0.48). The pooled incidence of 1-year @entity64 in @entity1 treated with angioplasty alone was 19.7% (95% CI, 16.6%-23.5%), compared with 14.2% (95% CI, 11.9%-16.9%) in the angioplasty-with-stent-treated @entity1 (RR, 1.39; P = 0.009). The incidence of technical success was 79.8% (95% CI, 74.7%-84.8%) in the angioplasty-alone group and 95% (95% CI, 93.4%-96.6%) in the angioplasty-with-stent-treated group (RR, 0.84; P < 0.0001). The pooled restenosis rate was 14.2% (95% CI, 11.8-16.6%) in the angioplasty-alone group, as compared with 11.1% (95% CI, 9.2%-13.0%) in the angioplasty-with-stent-treated group (RR, 1.28; P = 0.04). There was no effect of the publication year of the studies on the risk of @entity64 . CONCLUSION: Risk of 1-year @entity64 and rate of @entity256 may be lower in symptomatic @entity4522 @entity1 treated by angioplasty with stent placement compared with @entity1 treated by angioplasty alone.
