Staged versus index procedure complete revascularization in ST-elevation myocardial infarction: A meta-analysis.
J Interv Cardiol
; 30(5): 397-404, 2017 Oct.
Article
em En
| MEDLINE
| ID: mdl-28849628
ABSTRACT
BACKGROUND:
Complete revascularization of patients with ST-elevation myocardial infarction and multivessel coronary artery disease reduces adverse events compared to infarct-related artery only revascularization. Whether complete revascularization should be done as multivessel intervention during index procedure or as a staged procedure remains controversial.METHOD:
We performed a meta-analysis of randomized controlled trials comparing outcomes of multivessel intervention in patients with ST-elevation myocardial infarction and multivessel coronary artery disease as staged procedure versus at the time of index procedure. Composite of death or myocardial infarction was the primary outcome. Mantel-Haenszel risk ratios were calculated using random effect model.RESULTS:
Six randomized studies with a total of 1126 patients met our selection criteria. At a mean follow-up of 13 months, composite of myocardial infarction or death (7.2% vs 11.7%, RR 1.66, 95%CI 1.09-2.52, P = 0.02), all cause mortality (RR 2.55, 95%CI 1.42-4.58, P < 0.01), cardiovascular mortality (RR 2.8, 95%CI 1.33-5.86, P = 0.01), and short-term (<30 days) mortality (RR 3.54, 95%CI 1.51-8.29, P < 0.01) occurred less often in staged versus index procedure multivessel revascularization. There was no difference in major adverse cardiac events (RR 1.14, 95%CI 0.88-1.49, P = 0.33), repeat myocardial infarction (RR 1.14, 95%CI 0.68-1.92, P = 0.61), and repeat revascularization (RR 0.92, 95%CI 0.66-1.28, P = 0.62).CONCLUSION:
In patients with ST-elevation myocardial infarction and multivessel coronary artery disease, a strategy of complete revascularization as a staged procedure compared to index procedure revascularization results in reduced mortality without an increase in repeat myocardial infarction or need for repeat revascularization.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Infarto do Miocárdio com Supradesnível do Segmento ST
/
Revascularização Miocárdica
Tipo de estudo:
Clinical_trials
/
Etiology_studies
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Prognostic_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
J Interv Cardiol
Assunto da revista:
CARDIOLOGIA
Ano de publicação:
2017
Tipo de documento:
Article