scholarly journals Percutaneous coronary intervention versus medical therapy for chronic total coronary occlusions: a systematic review and meta-analysis of randomised trials

2020 ◽  
Vol 29 (1) ◽  
pp. 30-41 ◽  
Author(s):  
A. van Veelen ◽  
J. Elias ◽  
I. M. van Dongen ◽  
L. P. C. Hoebers ◽  
B. E. P. M. Claessen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Left Ventricular ◽  
Randomised Trials ◽  
Percutaneous Coronary

Abstract Background The results of chronic total occlusion percutaneous coronary intervention (CTO-PCI) trials are inconclusive. Therefore, we studied whether CTO-PCI leads to improvement of clinical endpoints and patient symptoms when combining all available randomised data. Methods and results This meta-analysis was registered in PROSPERO prior to starting. We performed a literature search and identified all randomised trials comparing CTO-PCI to optimal medical therapy alone (OMT). A total of five trials were included, comprising 1790 CTO patients, of whom 964 were randomised to PCI and 826 to OMT. The all-cause mortality was comparable between groups at 1‑year [risk ratio (RR) 1.70, 95% confidence interval (CI) 0.50–5.80, p = 0.40] and at 4‑year follow-up (RR 1.14, 95% CI 0.38–3.40, p = 0.81). There was no difference in the incidence of major adverse cardiac events (MACE) between groups at 1 year (RR 0.69, 95% CI 0.36–1.33, p = 0.27) and at 4 years (RR 0.85, 95% CI 0.60–1.22, p = 0.38). Left ventricular function and volumes at follow-up were comparable between groups. However, the PCI group had fewer target lesion revascularisations (RR 0.28, 95% CI 0.15–0.52, p < 0.001) and was more frequently free of angina at 1‑year follow-up (RR 0.65, 95% CI 0.50–0.84, p = 0.001), although the scores on the subscales of the Seattle Angina Questionnaire were comparable. Conclusion In conclusion, in this meta-analysis of 1790 CTO patients, CTO-PCI did not lead to an improvement in survival or in MACE as reported at long-term follow-up of up to 4 years, or to improvement of left ventricular function. However, CTO-PCI resulted in less angina and fewer target lesion revascularisations compared to OMT.

scholarly journals COMPARISON OF EFFECT OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION WITH STREPTOKINASE IN ACUTE ST ELEVATION MYOCARDIAL INFARCTION (STEMI) ON LEFT VENTRICULAR FUNCTION AFTER 3 MONTHS

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S860-64
Author(s):  
Saleha Abbas ◽  
Abdul Hameed Siddiqui ◽  
Ammar Cheema ◽  
Ayesha Abbas ◽  
Sadaf Khan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Primary Percutaneous Coronary Intervention ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Percutaneous Coronary ◽  
St Elevation

Objective: To assess the left ventricular function three months after the primary percutaneous coronary intervention versus Streptokinase in ST elevation myocardial infarction. Study Design: Prospective comparative study. Place and Duration of Study: Cardiac Catheterization Lab, in-patients and out patients departments of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from Jun 2018 to Jun 2019. Methodology: Patients included in the study were with first acute MI treated with primary PCI/SK, having systolic blood pressure >90 mmhg, pre-infarction EF >40% and with no previous history of coronary artery bypass grafting or angioplasty. All patients undergoing primary percutaneous coronary intervention/Streptokinase injection were assessed for left ventricular function at day one by transthoracic echocardiography and then three months later by transthoracic echocardiography. Two-dimensional echocardiography was being performed immediately after primary percutaneous coronary intervention on day one and at three months follow-up. Results: There were 80 patients recruited in the study. Mean age of the patients was 55.5 ± 11.6 years with range 36-81 years. Sixty nine (86.3%) patients were male while 11 (13.48%) were female patients. Most common comorbid was smoking 37 (46.3%) followed by diabetes mellitus 25 (31.3%). Most common culprit artery was left anterior descending 38 (47.5%) followed by left circumflex 15 (18.8%) and then right coronary artery 14 (17.5%). Independent sample t-test was applied to find out the statistical significance between two groups (Streptokinase group vs PPCI group). Ejection fraction of the patients was checked at the time of discharge and after three months follow-up and result showed the statistical significance with p-value <0.05. Conclusion: Based on this comparative analysis of improvement of left ventricular function between streptokinase and primary percutaneous coronary intervention, we concluded that after three months satisfactory ejection fraction is seen in patients treated with primary percutaneous coronary intervention as compared to patients treated with streptokinase.

scholarly journals Effect of Exercise-Based Cardiac Rehabilitation on Left Ventricular Function in Asian Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 774
Author(s):  
Yanjiao Wang ◽  
Ching-Wen Chien ◽  
Ying Xu ◽  
Tao-Hsin Tung
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Mean Difference ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Percutaneous Coronary

(1) Background: The effects of exercise-based cardiac rehabilitation (CR) on left ventricular function in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) are important but poorly understood. (2) Purpose: To evaluate the effects of an exercise-based CR program (exercise training alone or combined with psychosocial or educational interventions) compared with usual care on left ventricular function in patients with AMI receiving PCI. (3) Data sources, study selection and data extraction: We searched PubMed, WEB OF SCIENCE, EMBASE, EBSCO, PsycINFO, LILACS and Cochrane Central Register of Controlled Trials databases (CENTRAL) up to 12th June 2021. Article selected were randomized controlled trials and published as a full-text article. Meta-analysis was conducted with the use of the software Review manager 5.4. (4) Data synthesis: Eight trials were included in the meta-analysis, of which three trials were rated as high risk of bias. A significant improvement was seen in the exercise-based CR group compared with the control group regarding left ventricular ejection fraction (LVEF) (std. mean difference = 1.33; 95% CI:0.43 to 2.23; p = 0.004), left ventricular end-diastolic dimension (LVEDD) (std. mean difference = −3.05; 95% CI: −6.00 to −0.09; p = 0.04) and left ventricular end-systolic volume (LVESV) (std. mean difference = −0.40; 95% CI: −0.80 to −0.01; p = 0.04). Although exercise-based CR had no statistical effect in decreasing left ventricular end-systolic dimension (LVESD) and left ventricular end-diastolic volume (LVEDV), it showed a favorable trend in relation to both. (5) Conclusions: Exercise-based CR has beneficial effects on LV function and remodeling in AMI patients treated by PCI.

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