Twenty-nine RCTs (n=9,918) were included.
All of the studies analysed data on an intention-to-treat basis. Almost no patients were lost to follow-up. Blinding was not applicable given the nature of the interventions.
There was no statistically significant difference between routine stenting and standard PTCA for death or myocardial infarction (OR 0.90, 95% CrI: 0.72, 1.11), or the need for coronary artery bypass surgery (OR 1.01, 95% CrI: 0.79, 1.31).
Stenting significantly reduced the rate of restenosis (OR 0.52, 95% CrI: 0.37, 0.69) and the need for repeat PTCA (OR 0.59, 95% CrI: 0.50, 0.68).
The rates of crossover from PTCA to stenting ranged from 0 to 65%.
A smaller percentage of patients with documented angiographic stenosis originally assigned to stents underwent a second percutaneous intervention compared with those assigned to the PTCA group (68.6% versus 77.8% for the original PTCA group). After adjusting for the potential bias due to lack of blinding, the authors estimated that stents reduced repeated angioplasty by a smaller margin than the unadjusted estimates (OR 0.90, 95% CrI: 0.68, 1.18).
Six studies reported angina status. Angina disappeared or was reduced in 67% of the stent group versus 61% of the PTCA group (difference 6%, 95% CrI: 3, 9).