Fixedvs random effects meta-analysis in rare event studies: The Rosiglitazone link with myocardial infarction and cardiac death

2007 ◽  
Vol 26 (24) ◽  
pp. 4375-4385 ◽  
Author(s):  
Jonathan J. Shuster ◽  
Lynn S. Jones ◽  
Daniel A. Salmon
Keyword(s):  
Myocardial Infarction ◽  
Random Effects ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Rare Event ◽  
Event Studies

Abstract 14575: Systematic Review and Meta-analysis of Intravascular Ultrasound-guided Percutaneous Left-main Coronary Artery Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sameer Saleem ◽  
Shuaibahmed Arab ◽  
Waqas Ullah ◽  
Sundas Younas ◽  
Bashar Al hemyari ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Coronary Artery ◽  
Stent Implantation ◽  
Cardiac Death ◽  
Left Main Coronary Artery ◽  
Meta Analysis ◽  
Ultrasound Guided ◽  
Left Main ◽  
Relative Odds

Introduction: Previous meta-analyses have reported reduced cardiovascular mortality and myocardial infarction in intravascular ultrasound-guided (IVUS) stent implantation in comparison to angiography-only approach. However, these studies have unanimously excluded patients with unprotected left-main coronary artery (LMCA) disease, questioning its widespread applicability. We performed a systematic review and meta-analysis to investigate the prognostic significance of IVUS-guided LMCA intervention. Methods: Studies comparing clinical outcomes between IVUS-guided and angiography-only percutaneous LMCA intervention were identified through PubMed, Cochrane and EMBASE databases until June, 2020. Data was analyzed using a random effect model to calculate the relative odds of all-cause death, cardiac death, left-main revascularization, myocardial infarction, stent thrombosis and stroke. Results: A total of 13 studies comprising 7680 patients were included. The odds of all-cause death (OR 0.6, 95%CI 0.47-0.78; p<0.0001), cardiac death (OR 0.37, 95%CI 0.26-0.54; p<0.00001), left-main revascularization (OR 0.63, 95%CI 0.45-0.89; p=0.009) and myocardial infarction (OR 0.77 [95%CI 0.60-0.98; p=0.04]) were significantly lower in patients who underwent IVUS-guided LMCA stent implantation compared to angiography-only approach. There was no significant difference observed in the relative odds of stent thrombosis (OR 0.57, 95%CI 0.31-1.05; p=0.07) and stroke (OR 1.7, 95%CI 0.56-5.14; p=0.35) between the two arms at least 1-year of the index procedure. A subgroup analysis based on study design and sensitivity analysis based on the characteristics of the included studies mirrored the pooled results. Conclusion: IVUS-guided LMCA intervention is associated with overall improved cardiovascular outcomes than angiography-only approach. Large scale randomized controlled trials are needed to validate our findings.

279Clinical outcome after coronary bifurcation stenting: a systematic review and network meta-Analysis of PCI bifurcation techniques comprising 5572 patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Di Gioia ◽  
J Sonck ◽  
I Colaiori ◽  
T Mizukami ◽  
M Kodeboina ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Evaluation Framework ◽  
Left Main ◽  
Coronary Bifurcation ◽  
Bifurcation Lesions ◽  
Provisional Stenting ◽  
Crush Technique

Abstract Background The optimal PCI technique for bifurcation lesions remains a matter of debate. Several RCT have compared different bifurcation PCI techniques. Provisional stenting has been recommended as the default technique for most bifurcation lesions. However, emerging data suggests that double-kissing crush technique can be considered in true left main bifurcation lesions and has been endorsed by the European Society of Cardiology Guidelines. Purpose To compare the clinical outcome between different bifurcation PCI techniques. Methods We searched MEDLINE for randomized clinical trials (RCT) comparing PCI bifurcation techniques for coronary bifurcation lesions. Outcomes of interest were major adverse cardiovascular events (MACE) defined as the composite of cardiac death, myocardial infarction (MI) and target vessel or lesion revascularization (TVR/TLR), and the individual components of MACE. Stent thrombosis was assessed as defined by the ARC. Stratification based on left-main or distal bifurcations was performed. We evaluated the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We estimated summary odds ratios (ORs) using pairwise and Bayesian network meta-analysis. Results We identified 263 studies and of these included 19 RCT including 5572 patients treated with 5 bifurcation PCI techniques namely provisional stenting, systematic T-stenting, crush, culotte and double-kissing crush. Median follow-up was 12 months (IQR 8 to 36). When all bifurcation lesions were combined, double-kissing crush technique reduced the occurrence of MACE (OR 0.42; CrI 0.28 to 0.61) compared to provisional stenting. This difference was driven by a reduction in TVR/TLR (OR 0.39; CrI 0.25 to 0.65). No differences were found in cardiac death, MI or stent thrombosis among analyzed PCI techniques. No differences in MACE were observed between provisional stenting, systematic T-stenting, crush. In distal bifurcations (n=17 studies, 4634 patients), double-kissing crush also showed to reduce MACE (OR 0.48; CrI 0.29 to 0.67 vs. Provisional). In left-main bifurcations (n=3 studies, 938 patients) no differences in MACE were found between PCI techniques. Conclusions In this network meta-analysis, PCI bifurcation techniques were similar with respect to the occurrence of cardiac death, myocardial infarction and stent thrombosis. When all coronary bifurcations were combined, an advantage of double-kissing crush was observed in terms of MACE driven by lower rate of repeated revascularization. Further studies are required to define the best PCI bifurcation technique for left main coronary artery disease.

scholarly journals Impact of including or excluding both-armed zero-event studies on using standard meta-analysis methods for rare event outcome: a simulation study

BMJ Open ◽  
2016 ◽  
Vol 6 (8) ◽  
pp. e010983 ◽  
Author(s):  
Ji Cheng ◽  
Eleanor Pullenayegum ◽  
John K Marshall ◽  
Alfonso Iorio ◽  
Lehana Thabane
Keyword(s):  
Simulation Study ◽  
Meta Analysis ◽  
Rare Event ◽  
Event Studies ◽  
Analysis Methods ◽  
Zero Event

5193Percutaneous coronary intervention provided better result than optimal medical therapy in patients with chronic total occlusion: a metanalysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Khanra ◽  
B Duggal ◽  
I Basu Ray ◽  
B Kumar ◽  
R Walia
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
All Cause Mortality

Abstract Background Studies comparing the outcome of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) versus OMT alone in treatment of chronic total occlusion (CTO) are limited by observational design, variable follow up period, diverse clinical outcome, high drop-out and cross-over rate. Prematurely terminated DECISION CTO trail and the promising result of the most recent EUROCTO trial still left the quest unanswered. Previous metanalysis on the present context were restricted to studies with propensity-matched analysis only and did not incorporate the recent randomized trials. Purpose This study aims to conduct a meta-analysis of published data of observational as well as randomized studies comparing long term outcomes of PCI+OMT versus OMT alone. Methods The present protocol is registered in PROSPERO. PubMed, Embase and Cochrane databases were systematically reviewed. Fourteen studies meeting criteria were included in the meta-analysis. The Cochrane Risk of Bias scale was used to appraise the overall quality of the studies. Revman 5.3 software was used to analyse the data and random-effects model with inverse variance method was undertaken. R packages were used for assessment of bias and metaregression. Results Baseline parameters of both the groups were comparable. Major adverse cardiovascular events (MACE) which comprises of cardiac death, myocardial infarction, stroke, and unplanned revascularization [Figure 1] were significantly lower in the PCI+OMT group. (RR: 0.77; 95% CI: 0.61 to 0.97; P≤0.ehz746.00521; I2=85%). High heterogeneity was partially (14%) explained by age factor. However study design, follow up duration, LVEF, presence of TVD did not attribute significantly to heterogeneity, in isolation or any combination in metregression model. All cause mortality and cardiac death [Figure 2, 3 respectively] were significantly lower in the PCI+OMT group (P=0.29, p=0.63, respectively). Myocardial infarction (P=0.25) and stroke rates (P=0.15) were lower in the PCI+OMT group, however they did not reach statistical significance. Unplanned revascularization (of any vessel) showed a higher trend in the PCI+OMT group, without reaching statistical significance (P=0.46, I2=88%). Conclusion PCI of CTO is rewarded with better long term outcome, in terms of MACE and all-cause mortality but limited to greater unplanned revascularization. Acknowledgement/Funding None

scholarly journals Intensive versus Usual Control of Hypertension in the Prevention of Cardiovascular and Renal Outcomes: A Cumulative Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 44 (3) ◽  
pp. 384-395 ◽  
Author(s):  
Li Li ◽  
Ling Li
Keyword(s):  
Myocardial Infarction ◽  
Randomized Controlled Trials ◽  
Cardiac Death ◽  
Cardiovascular Events ◽  
Treatment Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Renal Outcomes ◽  
Randomized Controlled ◽  
Major Cardiovascular Events

Background/Aims: Previous studies have reported inconsistent results regarding the treatment effects of intensive blood pressure (IBP) control in the prevention of cardiovascular and renal outcomes. We conducted this cumulative meta-analysis to evaluate the treatment effects of IBP control on cardiovascular and renal outcomes. Methods: We systematically searched PubMed, EMBASE, and the Cochrane Library databases from the date of their inception to October 2017, to identify randomized controlled trials (RCTs). The relative risks (RRs) with corresponding 95% confidence intervals (CIs) were used to evaluate the treatment effects of IBP control by using a random-effects model. Results: The final analysis included 20 RCTs involving 56,687 individuals. The summary RRs indicated that IBP control treatment significantly reduced the risk of major cardiovascular events (RR: 0.85; 95% CI: 0.77–0.94; p = 0.001), including myocardial infarction (RR: 0.87; 95% CI: 0.76–1.00; p = 0.044), stroke (RR: 0.77; 95% CI: 0.66–0.89; p < 0.001), and albuminuria (RR: 0.90; 95% CI: 0.84–0.97; p = 0.007). However, IBP control had no significant effect on heart failure (RR: 0.80; 95% CI: 0.62–1.03; p = 0.077), all-cause mortality (RR: 0.91; 95% CI: 0.81–1.02; p = 0.112), cardiac death (RR: 0.91; 95% CI: 0.75–1.12; p = 0.390), non-cardiac death (RR: 0.98; 95% CI: 0.86–1.12; p = 0.773), end-stage renal disease (RR: 0.90; 95% CI: 0.77–1.06; p = 0.203), and retinopathy (RR: 0.81; 95% CI: 0.66–1.00; p = 0.052). Conclusion: The findings of this study suggest that IBP control plays a beneficial role in the prevention of some major cardiovascular events, including myocardial infarction, stroke, and albuminuria.

scholarly journals Comparison of new-generation drug-eluting stents versus drug-coated balloon for in-stent restenosis: a meta-analysis of randomised controlled trials

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e017231 ◽  
Author(s):  
Jin-Zan Cai ◽  
Yong-Xiang Zhu ◽  
Xin-Yu Wang ◽  
Christos V Bourantas ◽  
Javaid Iqbal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Drug Eluting Stents ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
New Generation ◽  
Drug Coated Balloon ◽  
In Stent Restenosis

ObjectiveThe study sought to compare angiographic and clinical outcomes of new-generation drug-eluting stents (DES) versus drug-coated balloon (DCB) in patients with coronary in-stent restenosis (ISR).DesignMeta-analysis using data from randomised trial found by searches on PubMed, the Cochrane Library, ClinicalTrials.gov and websites of major cardiovascular congresses.SettingOnly randomised trials comparing DES with DCB were included.ParticipantsPatients with ISR in the included trials.InterventionsNew-generation DES versus DCB.OutcomesThe angiographic and clinical outcomes including cardiac death, all-cause death, myocardial infarction, target lesion revascularisation (TLR), target vessel revascularisation (TVR), major adverse cardiac events (MACE) and stent thrombosis were investigated.ResultsFive trials including 913 patients were eligible and included. Pooled analysis in angiographic results identified that new-generation DES were associated with higher acute luminal gain (−0.31 mm, 95% CI −0.42 to −0.20, P<0.001) and lower per cent diameter stenosis (risk ratio (RR): 0.28, 95% CI 0.02 to 0.55, P=0.04). DES significantly reduced the risk of TLR (RR: 1.96, 95% CI 1.17 to 3.28, P=0.01) compared with DCB; however, there was no statistical differences for MACE (RR: 1.21, 95% CI 0.67 to 2.17, P=0.53), myocardial infarction (RR: 1.16, 95% CI 0.55 to 2.48, P=0.69) and cardiac death (RR: 1.80, 95% CI 0.60 to 5.39, P=0.29).ConclusionsInterventions with new-generation DES appear to be associated with significant reduction in per cent diameter stenosis and TLR at short-term follow-up, but had similar MACE, myocardial infarction and cardiac death for patients with coronary ISR compared with DCB. Appropriately powered studies with longer term follow-up are warranted to confirm these findings.

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