Authors' objectives:

The following questions are addressed in this review:

1.What are the effects and effectiveness of elective stent insertion versus percutaneous transluminal coronary angioplasty (PTCA) in subacute ischaemic heart disease (IHD), particularly stable angina and unstable angina? 2.What are the effects and effectiveness of elective stent insertion versus coronary artery bypass graft surgery (CABG) in subacute IHD, particularly stable angina and unstable angina? 3.What are the effects and effectiveness of elective stent insertion versus PTCA in acute myocardial infarction (AMI)? 4.What are best estimates of UK cost for elective stent insertion, PTCA and CABG in the circumstances of review questions 1 to 3? 5.What are best estimates of cost-effectiveness and costutility for elective stent insertion relative to PTCA or CABG in the circumstances of review questions 1 to 3?

Authors' results and conclusions: Thirty-five RCTs which fulfilled the study criteria were found: 25 compared stent with PTCA for subacute IHD; three compared stents with CABG for subacute IHD; seven compared stents with PTCA following AMI. In general, the trials were open to bias, which introduced uncertainty. Despite this, convincing evidence of impact was identified in the following. 1.Elective stent insertion versus PTCA in subacute IHD for: - event rates (generally death, MI, repeat PTCA and CABG) odds ratio (OR), 0.68 (95% confidence interval [CI], 0.59 to 0.78) - repeat PTCA OR, 0.57 (95% CI, 0.48 to 0.69) 2.Elective stent insertion versus PTCA in AMI for: - event rates (generally death, MI, repeat PTCA and CABG) OR, 0.39 (95% CI, 0.28 to 0.54) - repeat PTCA OR, 0.44 (95% CI, 0.26 to 0.74). There was no clear evidence of impact on deaths, MI or CABG in comparison (1) or (2) above. Although trials were identified, there was insufficient evidence to draw any conclusions on the effectiveness of elective stent insertion versus CABG in subacute IHD.

Authors' recommendations: In subacute IHD (especially stable angina and unstable angina), there is evidence for the effectiveness of elective stents in reducing the need for repeat PTCA. This appears to represent an efficient use of resources. However, this assertion could be made with more confidence if the resource neutrality of stents could be confirmed using more rigorously derived cost data. There is currently insufficient evidence to assess the effectiveness of the extension of stent use to patients with baseline risks or indications different from those of the patients in the trials reviewed (for review question 1).

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1168

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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