Pioglitazone and the Risk of Myocardial Infarction and Other Major Adverse Cardiac Events: A Meta-Analysis of Randomized, Controlled Trials

Background: The effects of intracoronary (IC) thrombolysis therapy in patients with ST-segment elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PPCI) remain unclear. Methods: The meta-analysis was conducted according to the PRISMA statement. All relevant studies were identified by searching the PubMed, EMBASE, Cochrane Library, and Web of Science, with no time or language limitation. The pooled risk ratio (RR) and weighted mean difference (WMD) with a 95% CI were calculated. Results: Nine randomized controlled trials involving a total of 1341 patients were included. Compared with the control group, IC thrombolysis in patients with STEMI could reduce the incidence of major adverse cardiac events (MACE; RR 0.632, 95% CI, 0.474-0.843, P = .002) and improve left ventricular ejection fraction (RR 0.343, 95% CI, 0.178-0.509, P < .001) and myocardial microcirculation. However, there was no difference noted in the mortality (RR 0.759, 95% CI, 0.347-1.661, P = .490). The incidence rate of major bleeding and minor bleeding was comparable between the 2 groups. Conclusions: Intracoronary thrombolysis was associated with improved MACE and myocardial microcirculation in patients with STEMI having PPCI, though it failed to improve mortality.

Download Full-text

Complete versus culprit-only PCI in patients with STEMI and multivessel disease: a systematic review and meta-analysis of randomized controlled trials

European Heart Journal ◽

10.1093/ehjci/ehaa946.1740 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.Y Levett ◽

S.B Windle ◽

K.B Filion ◽

J Cabaussel ◽

M.J Eisenberg

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Complete Revascularization ◽

Funding Source ◽

Randomized Controlled ◽

Mcgill University ◽

Scholar Award

Abstract Background Approximately half of patients with ST-segment elevation myocardial infarction (STEMI) present with multivessel coronary artery disease (CAD) during primary percutaneous coronary intervention (PCI). Purpose To compare the risks of major cardiovascular outcomes and procedural complications in patients with STEMI and multivessel CAD randomized to complete revascularization versus culprit-only PCI. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing complete to culprit-only PCI, identified via a systematic search of MEDLINE, Embase, and the Cochrane Libraries. Count data were pooled using DerSimonian and Laird random-effects models with inverse variance weighting to obtain relative risks (RRs) and corresponding 95% confidence intervals (CIs). Results A total of 8 RCTs (n=6,632) were included, with mean/median follow-up times ranging from 6 to 36 months. Compared to culprit-only PCI, complete PCI was associated with a substantial reduction in MACE (12.6% vs. 22.0%), repeat myocardial infarction (4.5% vs. 6.9%), and repeat revascularization (3.3% vs. 12.1%) (Table 1). Complete PCI may also improve all-cause and cardiovascular mortality, but estimates were accompanied by wide 95% CIs. Findings for stroke, major bleeding, and contrast-induced AKI were inconclusive. Conclusion Complete revascularization appears to confer benefit over culprit-only PCI in patients with STEMI and multivessel CAD, and should be considered a first-line strategy in these patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Mr. Levett is supported by a Dr. Clarke K. McLeod Memorial Scholarship, funded through the McGill University Faculty of Medicine Research Bursary Program. Dr. Filion is supported by a Junior 2 Research Scholar award from the Fonds de recherche du Québec – Santé and a William Dawson Scholar award from McGill University.

Download Full-text