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Table 11.5Medical vs. CABG – Single vessel disease – Long term follow-up (>4 years) for stable angina

Quality assessmentSummary of findings
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsMedicalCABGRelative (95% CI)Absolute
Death (follow-up 5–10 years)
Alderman 199074 (CASS); Kloster 197976; Hueb 199986 (MASS-I)randomised trialsserious (a)no serious inconsistencyno serious indirectnessserious (b)None26/189 (13.8%)18/185 (9.7%)RR 1.41 (0.81 to 2.46)40 more per 1000 (from 18 fewer to 142 more)[plus sign in circle][plus sign in circle]○○

LOW
Cardiac death (follow-up 5 years)
Hueb 199986 (MASS-I)randomised trialsserious (c)no serious inconsistencyno serious indirectnessserious (b)None2/72 (2.8%)2/70 (2.9%)RR 0.97 (0.14 to 6.71)1 fewer per 1000 (from 25 fewer to 163 more)[plus sign in circle][plus sign in circle]○○

LOW
MI (follow-up 5 years)
Hueb 199986 (MASS-I)randomised trialsserious (c)no serious inconsistencyno serious indirectnessserious (b)None3/72 (4.2%)3/70 (1.4%)RR 0.97 (0.20 to 4.66)27 more per 1000 (from 10 fewer to 377 more)[plus sign in circle][plus sign in circle]○○

LOW
Stroke (follow-up 5 years)
Hueb 199986 (MASS-I)randomised trialsserious (c)no serious inconsistencyno serious indirectnessserious (b)None1/72 (1.4%)1/70 (1.4%)RR 0.97 (0.06 to 15.24)0 fewer per 1000 (from 13 fewer to 203 more)[plus sign in circle][plus sign in circle]○○

LOW
Non protocol revascularisation (follow-up 5 years)
Hueb 199986 (MASS-I)randomised trialsserious (c)no serious inconsistencyno serious indirectnessno serious imprecisionNone12/72 (16.7%)0/70 (0%)RR 24.32 (1.47 to 402.97)170 more per 1000 (from 80 more to 260 more).[plus sign in circle][plus sign in circle][plus sign in circle]

MODERATE
Free of angina (follow-up 5 years)
Hueb 199986 (MASS-I)randomised trialsserious (c)no serious inconsistencyno serious indirectnessno serious imprecisionNone17/72 (23.6%)48/70 (68.6%)RR 0.34 (0.22 to 0.54)453 fewer per 1000 (from 315 fewer to 535 fewer)[plus sign in circle][plus sign in circle][plus sign in circle]

MODERATE
a

Alderman 1990[72] (CASS); Kloster 1979[74]; Hueb 1999[84] (MASS-I): All 3 Randomised. ITT not reported in Kloster 1979[74]. Allocation concealment not reported in all 3 papers.

b

95% CI around the pooled estimate of effect includes both: 1) no effect and 2) appreciable benefit or appreciable harm.

c

Hueb 1999[84] (MASS-I): Randomised, Baseline comparisons made. Number of patients lost to follow-up not reported. ITT reported. Limitations: allocation concealment not reported. Blinding of outcome assessors not reported.

Alderman 1990[72] (CASS); Kloster 1979[74]; Hueb 1999[84] (MASS-I): All 3 Randomised. ITT not reported in Kloster 1979[74]. Allocation concealment not reported in all 3 papers.

95% CI around the pooled estimate of effect includes both: 1) no effect and 2) appreciable benefit or appreciable harm.

Hueb 1999[84] (MASS-I): Randomised, Baseline comparisons made. Number of patients lost to follow-up not reported. ITT reported. Limitations: allocation concealment not reported. Blinding of outcome assessors not reported.

From: 11, Medical versus revascularisation interventions

Cover of Stable Angina
Stable Angina: Methods, Evidence & Guidance [Internet].
NICE Clinical Guidelines, No. 126.
National Clinical Guidelines Centre (UK).
Copyright © 2011, National Clinical Guidelines Centre.

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