Comparison of revascularization strategies in patients with acute coronary syndrome and multivessel coronary disease: A systematic review and network meta-analysis.
Catheter Cardiovasc Interv
; 96(4): E447-E454, 2020 10 01.
Article
in En
| MEDLINE
| ID: mdl-32222063
ABSTRACT
BACKGROUND:
Whether revascularization should be performed as multivessel intervention at the time of index procedure (MV-index), staged procedure (MV-staged), or culprit only intervention (COI) in patients with multivessel disease (MVD) presenting with acute coronary syndrome (ACS) is unclear. We performed a systematic review and network meta-analysis of randomized controlled trials to assess the optimal revascularization strategy in this patient population.METHODS:
PubMed, Embase, and Cochrane Central databases were systematically searched to identify all relevant studies. The outcomes assessed were major cardiac adverse events (MACE), all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and revascularization. A Bayesian random-effects network meta-analysis was used to calculate odds ratio (OR) with credible interval (CrI).RESULTS:
Thirteen studies with 8,066 patients were included in the analysis. There was a decreased risk of MACE (MV-index vs. COI OR, 0.35; 95% CrI, 0.23-0.55; MV-staged vs COI OR, 0.52; 95% CrI, 0.31-0.81) and revascularization (MV-index vs. COI OR, 0.27; 95% CrI, 0.15-0.49; MV-staged vs. COI OR, 0.38; 95% CrI, 0.19-0.70) with MV-index intervention and MV-staged intervention compared with COI. However, MV-index intervention and not MV-staged intervention was associated with a decreased risk of MI (MV-index vs. COI OR, 0.35; 95% CrI, 0.12-0.93; MV-staged vs. COI OR, 0.65; 95% CrI, 0.24-1.59) compared with COI.CONCLUSIONS:
Our analysis suggests that multivessel intervention either at index procedure or as staged intervention may be more efficacious compared to COI in patients with MVD presenting with ACS.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Coronary Artery Disease
/
Acute Coronary Syndrome
/
Non-ST Elevated Myocardial Infarction
/
ST Elevation Myocardial Infarction
/
Myocardial Revascularization
Type of study:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
Catheter Cardiovasc Interv
Journal subject:
CARDIOLOGIA
Year:
2020
Type:
Article
Affiliation country:
United States