Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Autor: Cristina Sanina, David F. Briceño, Felipe N. Albuquerque, Ankur Kalra, Michael J. Attubato, Jose Wiley, Tanush Gupta, Wilman Olmedo, Michael Weinreich, Emily Ong, Mark Menegus, Harish Ramakrishna, Pedro A. Villablanca, Divyanshu Mohananey, Ibrahim Kassas, Thomas Brevik
Jazyk: angličtina
Rok vydání: 2018
Předmět:
medicine.medical_specialty
Percutaneous
medicine.medical_treatment
030204 cardiovascular system & hematology
Coronary Angiography
03 medical and health sciences
Electrocardiography
0302 clinical medicine
Catheter-Based Coronary and Valvular Interventions
Internal medicine
Intervention (counseling)
medicine
ST segment
Humans
In patient
030212 general & internal medicine
Myocardial infarction
ST‐segment–elevation myocardial infarction
chronic total occlusion
Systematic Review and Meta‐Analysis
business.industry
Revascularization
percutaneous coronary intervention
Percutaneous coronary intervention
medicine.disease
medicine.anatomical_structure
Treatment Outcome
Coronary Occlusion
meta‐analysis
Meta-analysis
Chronic Disease
Cardiology
ST Elevation Myocardial Infarction
Cardiology and Cardiovascular Medicine
business
Artery
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Background Studies have shown that chronic total occlusion ( CTO ) in a noninfarct‐related artery in patients with ST‐segment–elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct‐related artery CTO in patients with ST‐segment–elevation myocardial infarction translates to improved outcomes. We performed a meta‐analysis to compare outcomes between patients presenting with ST‐segment–elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct‐related artery CTO versus those who did not. Method and Results We conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all‐cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios ( ORs ) and 95% confidence intervals ( CIs ) were computed. Random effects model was used and heterogeneity was considered if I 2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events ( OR , 0.54; 95% CI , 0.32–0.91), cardiovascular mortality ( OR , 0.43; 95% CI , 0.20–0.95), and heart failure readmissions ( OR , 0.57; 95% CI , 0.36–0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all‐cause mortality ( OR , 0.47; 95% CI , 0.22–1.00), myocardial infarction ( OR , 0.78; 95% CI , 0.41–1.46), repeat revascularization ( OR , 1.13; 95% CI , 0.56–2.27), and stroke ( OR , 0.51; 95% CI , 0.20–1.33). Conclusions In this meta‐analysis, CTO percutaneous coronary intervention of the noninfarct‐related artery in patients presenting with ST‐segment–elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.
Databáze: OpenAIRE
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