Worse clinical outcomes following percutaneous coronary intervention with a high SYNTAX score: A systematic review and meta-analysis
| Autor: | Feng Huang, Akash Bhurtu, Pravesh Kumar Bundhun |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Coronary angiography
medicine.medical_specialty medicine.medical_treatment MEDLINE 030204 cardiovascular system & hematology Coronary Angiography multi-vessel coronary artery diseases Coronary artery disease 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine Percutaneous Coronary Intervention Internal medicine medicine Humans 030212 general & internal medicine cardiovascular diseases Coronary Artery Bypass coronary artery bypass surgery business.industry left main coronary artery diseases Percutaneous coronary intervention General Medicine medicine.disease humanities Cardiac surgery SYNTAX score surgical procedures operative Treatment Outcome Meta-analysis Conventional PCI Cardiology business Systematic Review and Meta-Analysis Research Article |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 |
| Popis: | Background: The synergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) score is an angiographic tool which is used to determine the complexity of coronary artery disease (CAD). We aimed to compare PCI versus coronary artery bypass surgery (CABG) in patients with a high SYNTAX score in order to confirm with evidence whether the former is really association with worse clinical outcomes. Methods: The National database of medical research articles (MEDLINE/PubMed), EMBASE database, and the Cochrane library were searched for publications comparing PCI versus CABG in patients with a high SYNTAX score, respectively. Death, myocardial infarction (MI), stroke, repeated revascularization, and a combined outcome death/stroke/MI were considered as the clinical endpoints. RevMan software was used to analyze the data, whereby odds ratios (OR) with 95% confidence intervals (CI) were used as the statistical parameters. Results: A total number of 1074 patients were included (455 patients with a high SYNTAX score were classified in the PCI group and 619 other patients with a high SYNTAX score were classified in the CABG group). A SYNTAX score cut-off value of ≥33 was considered relevant. Compared with CABG, mortality was significantly higher with a high SYNTAX score following PCI with OR: 1.79, 95% CI: 1.18 to 2.70; P = .006, I2 = 0%. The combined outcome death/stroke/MI was also significantly higher following PCI with a high SYNTAX score, with OR: 1.69, 95% CI: 1.24 to 2.30; P = .0009, I2 = 0%. In addition, PCI was also associated with significantly higher MI and repeated revascularization when compared with CABG, with OR: 3.72, 95% CI: 1.75 to 7.89; P = .0006, I2 = 0% and OR: 4.33, 95% CI: 1.71 to 10.94; P = .002, I2 = 77%, respectively. However, stroke was not significantly different. Conclusions: Compared with CABG, worse clinical outcomes were observed following PCI in patients with a high SYNTAX score, confirming with evidence, published clinical literatures. Therefore, CABG should be recommended to CAD patients who have been allotted a high SYNTAX score. |
| Databáze: | OpenAIRE |
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