Sixty three RCTs were included (n=25,388; range 41 to 2286); median follow-up was 12 months (interquartile range 6 to 24 months). One trial was reported as being triple-blind, 12 as double blind, seven reported blinding the outcome assessor, one was open label; blinding was not reported in the other trials.
No direct comparison showed a significant difference between groups in terms of mortality or MI. The only direct comparisons to show a statistically significant results were a reduction in CABG with drug eluting stents compared to bare metal stents (RR 0.56, 95% CI: 0.36, 0.88; 12 trials) and target vessel/lesion revascularisation with bare metal stents compared to PTCA (RR 0.68, 95% CI: 0.60, 0.77; 32 trials). Statistically significant heterogeneity was observed for the revascularisation outcomes, and MI in PTCA versus medical therapy.
When indirect evidence was taken into account, there was a significant reduction in: revascularisation with bare metal stents compared to medical therapy (RR 0.71, 95% CI: 0.58, 0.87); CABG with drug eluting stents compared to medical therapy (RR 0.58, 95% CI: 0.38, 0.88); target vessel/lesion revascularisation (RR 0.68, 95% CI: 0.60, 0.77) and revascularisation (RR 0.77, 95% CI: 0.61, 0.99) with bare metal stents versus PTCA; CABG (RR 0.55, 95% CI: 0.37, 0.81) and target vessel/lesion revascularisation (RR 0.30, 95% CI: 0.17, 0.51) with drug eluting stents versus PTCA; and CABG (RR 0.56, 95% CI: 0.39, 0.80) and target vessel/lesion revascularisation (RR 0.44, 95% CI: 0.35, 0.56) with drug eluting stents versus bare metal stents. No direct evidence was available for drug eluting stents versus PTCA or medical therapy.
Subgroup and sensitivity analyses did not alter the results of the main analyses (data not reported).