BMJ 2000;321:1408 ( 2 December )

Letters

Studies in meta-analysis of treatment of stable angina had methodological flaws

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EDITOR---Bucher et al's meta-analysis of the treatment of stable angina with percutaneous transluminal coronary angioplasty or medical treatment is based on a small number of trials with methodological flaws. 1 2 The conclusions could have considerable adverse effects on the provision of revascularisation services, and we wish to draw attention to problems with the meta-analysis. Its results should not be used to guide clinical practice or decision making in public health.

Sievers et al recruited asymptomatic patients to randomisation between angioplasty and medical treatment.3 The atorvastatin versus revascularisation treatment (AVERT) study recruited patients who were asymptomatic or had only minimal symptoms, many of whom had only moderate coronary lesions.4 The medicine, angioplasty, or surgery study (MASS) recruited only patients with angina and a severe, very proximal, stenosis of the left anterior descending artery, who were randomised to surgery, angioplasty, or medical treatment, with an improvement in outcome after surgery.5

It . . . [Full text of this article]
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Relevant Article

Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials
Heiner C Bucher, Peter Hengstler, Christian Schindler, and Gordon H Guyatt
BMJ 2000 321: 73-77. [Abstract] [Full Text] [PDF]

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