Outcomes of Coronary Artery Bypass Grafting in Patients With Poor Myocardial Viability: A Systematic Review and Meta-Analysis of the Last Decade.

Autor: Sharma VJ; Department of Cardiac Surgery, Austin Health, Heidelberg, Melbourne, Vic, Australia; Department of Surgery (Austin Health), Melbourne Medical School, Heidelberg, Melbourne, Vic, Australia; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA. Electronic address: sharma.varun.j@gmail.com., Arghami A; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA., Pasupula DK; Department of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA., Haddad A; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA., Ke JXC; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Canada; Department of Anesthesia, Providence Health Care, Vancouver, Canada; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2022 Jul; Vol. 31 (7), pp. 916-923. Date of Electronic Publication: 2022 Mar 24.
DOI: 10.1016/j.hlc.2021.12.016
Abstrakt: Objectives: Our objective is to assess whether the presence of myocardial viability is a predictor of mortality among patients undergoing coronary artery bypasss grafting (CABG) through a systematic review meta-analysis.
Methods: Comprehensive review of EMBASE and PubMed in accordance with PRISMA guidelines, including studies of patients undergoing CABG with assessment of myocardial viability and recorded long-term mortality, age and sex. Studies were restricted to the last decade, and data were stratified by imaging modality (magnetic resonance imaging [MRI] or nuclear medicine). Random-effects model for assessing pooled effect, heterogeneity assessment using Chi-square and I 2 statistics, publication bias assessed by funnel plots and Egger's test.
Results: Meta-analysis of contemporary data (January 2010 to October 2020) yielded 3,621 manuscripts of which 92 were relevant, and 6 appropriate for inclusion with 993 patients. Pooled analysis showed that patients with non-viable myocardium undergoing CABG are at 1.34 times the risk of mortality compared to those with viable myocardium (95% CI 1.01-1.79, p=0.05). Subgroup analysis of the MRI or nuclear medicine modalities was not statistically significant and there was no confounding by age or sex in meta-regression. There was significant heterogeneity in imaging modality and diagnostic criteria, but heterogeneity between study findings was low with an I 2 statistic of 29%. The risk of publication bias was moderate on the Newcastle-Ottawa Scale), but not statistically significant (Egger's Test coefficient=1.3, 95%CI -0.35-2.61, p=0.10).
Conclusions: There is a multitude of methods for assessing cardiac viability for coronary revascularisation surgery, making meta-analyses fraught with limitations. Our meta-analysis demonstrates that the finding of non-viable myocardium can not be used draw conclusions for risk assessment in coronary surgery.
(Crown Copyright © 2022. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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