Soriano-Moreno David R, Fernandez-Guzman Daniel, Tuco Kimberly G, Soriano-Moreno Anderson N, Ccami-Bernal Fabricio, Coico-Lama Abdiel H, Gonzáles-Uribe Antony G, Taype-Rondan Alvaro
Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru.
Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Peru.
Heliyon. 2024 Mar 2;10(5):e27210. doi: 10.1016/j.heliyon.2024.e27210. eCollection 2024 Mar 15.
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.
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).
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.
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.
稳定型冠状动脉疾病的侵入性治疗仍是一个有争议的话题。本伞状综述的目的是综合系统评价（SRs），以评估经皮冠状动脉介入治疗（PCI）与最佳药物治疗（OMT）对稳定型冠状动脉疾病患者的益处和危害。
我们系统检索了2018年至2022年8月7日的PubMed/MEDLINE、Embase和CENTRAL。我们纳入了对随机对照试验（RCTs）进行荟萃分析的SRs，这些试验评估了感兴趣的问题。我们使用AMSTAR-2工具评估了SRs的方法学质量。我们总结了每个SR的结局结果。我们使用校正覆盖面积（CCA）计算了SRs中纳入的RCTs的重叠程度。
我们发现了10个进行荟萃分析的SRs。这些SRs纳入了3至15项RCTs。SRs之间的重叠程度非常高（CCA>15%）。没有SR使用GRADE系统评估证据的确定性，10个中有9个方法学质量极低。SRs报告了全因死亡率、心肌梗死、血运重建和心绞痛结局的异质性结果。另一方面，对于心血管死亡率和中风结局，所有SRs都一致认为PCI和单独的OMT之间没有差异。
我们发现了10个关于稳定型冠状动脉疾病患者使用PCI与单独OMT对比的SRs。然而，没有一个具有高方法学质量，没有一个使用GRADE方法评估证据的确定性，并且几个结局的结果不一致。这种证据的变异性可能导致医疗保健专业人员在稳定型冠状动脉疾病管理方面做出不同的临床决策。有必要使用GRADE方法进行高质量的SR，以阐明PCI的利弊平衡。
