Optimal percutaneous coronary intervention in patients with ST-elevation myocardial infarction and multivessel disease: An updated, large-scale systematic review and meta-analysis
| Autor: | Nguyen Lam Vuong, Omer Abdelbagi Omer, Ahmed Abdou Mohamed, Aya Ashraf Ali, Sara Attia Mahmoud Abdelrahman, Mohamed Gomaa Kamel, Nam Nguyen Nho Hoang, Mohamed Ashraf Mokhtar, Fatma Abd-Elshahed Abd-Elhay, Mohamed EL-Mekawy, Le Van Thanh, Kenji Hirayama, Nguyen Tien Huy, An Vu Nguyen |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Population Coronary Artery Disease 030204 cardiovascular system & hematology Revascularization Culprit 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Internal medicine Myocardial Revascularization medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction education Stroke Randomized Controlled Trials as Topic education.field_of_study business.industry Percutaneous coronary intervention medicine.disease Conventional PCI Cardiology ST Elevation Myocardial Infarction Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | International Journal of Cardiology. 244:67-76 |
| ISSN: | 0167-5273 |
| Popis: | Background Our study aimed to compare three different percutaneous coronary intervention (PCI) approaches: culprit-only (COR) and complete (CR) revascularization – categorizing into immediate (ICR) or staged (SCR). Methods We searched 13 databases for randomized controlled trials. Articles were included if they compared at least two strategies. To have more studies in each analysis, an adjusted analysis was performed using person-years to incorporate follow-up durations and obtain pooled rate ratios (RR), with their corresponding 95% confidence interval. Results Thirteen trials were included with a population of 2830 patients. COR significantly increased major adverse cardiac event (MACE) (adjusted RR 1.67, 95% CI: 1.27–2.19) and repeat revascularization (2.12, 1.67–2.69), which was driven by repeat PCI, without any difference in all-cause mortality and myocardial infarction (MI) compared to CR. When categorizing CR into SCR and ICR, the trend repeated with COR increased MACE (1.99, 1.53–2.6 for ICR), cardiovascular mortality (2.06, 1.07–3.96 for ICR), MI for ICR (1.72, 1.04–2.86), repeat revascularization and repeat PCI for both ICR and SCR. Non-cardiovascular mortality, stroke, nephropathy, re-hospitalization, stent thrombosis and bleeding were similar among all approaches. Conclusions In MVD-STEMI patients, CR is better than COR in terms of MACE, cardiovascular mortality, repeat revascularization with no difference in safety outcomes. There was a trend towards to a reduction of cardiovascular mortality and MI in ICR compared to SCR when each matched with COR; even though there is no statistically significant difference between ICR and SCR when compared together. |
| Databáze: | OpenAIRE |
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