Clinical Outcomes of Manual Aspiration Thrombectomy in Patients with Acute Myocardial Infarction: An Updated Meta-Analysis

Cardiology ◽  
2015 ◽  
Vol 132 (2) ◽  
pp. 124-130 ◽  
Author(s):  
Alexandros Briasoulis ◽  
Mohan Palla ◽  
Luis Afonso
Keyword(s):  
Myocardial Infarction ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Aspiration Thrombectomy ◽  
Medline Search ◽  
Target Vessel Revascularization ◽  
Major Cardiovascular Events ◽  
All Cause Mortality

Background: Recent trials on manual aspiration thrombectomy (AT) in patients with ST-elevation myocardial infarction did not show any significant benefits of AT. Aims: The present meta-analysis was designed to systematically evaluate prospective randomized trials and assess the effects of AT on all-cause mortality, major cardiovascular events (MACE), target vessel revascularization, myocardial reinfarction, stroke and surrogate myocardial perfusion markers. Methods and Results: We conducted an EMBASE and MEDLINE search for studies in which patients were randomized to treatment with AT plus primary percutaneous coronary intervention (PCI) versus PCI. We identified 16 prospective randomized trials which enrolled 10,437 controls that underwent conventional PCI and 10,385 patients who underwent PCI with AT with an average follow-up duration of 5.8 months. A significant reduction in MACE with AT was noted (OR 0.91; 95% CI 0.82-0.99; p = 0.04). In spite of improved TIMI 3 and myocardial blush grade 3 rates, AT did not significantly reduce all-cause mortality, target-vessel revascularization and myocardial infarction. Stroke rates were increased with AT. Conclusion: The results of this large meta-analysis of 20,822 patients suggest that adjunctive AT to PCI may be associated with improved myocardial reperfusion but limited benefits related to the clinical end-points.

scholarly journals Everolimus-Eluting versus Paclitaxel-Eluting Stents in Percutaneous Coronary Intervention: Meta-Analysis of Randomized Trials

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ashraf Alazzoni ◽  
Ayman Al-Saleh ◽  
Sanjit S. Jolly
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Target Vessel Revascularization ◽  
Percutaneous Coronary

Background. Individual randomized trials have suggested that everolimus-eluting stents may have improved clinical outcomes compared to paclitaxel-eluting stents, but individual trials are underpowered to examine outcomes such as mortality and very late stent thrombosis. Methods. Medline, Cochrane, and conference proceedings were searched for randomized trials comparing everolimus versus paclitaxel-eluting stents for percutaneous coronary intervention. Results. 6792 patients were included from 4 randomized controlled trials. Stent thrombosis was reduced with everolimus stents versus paclitaxel stents (0.7% versus 2.3%; OR: 0.32; CI: 0.20–0.51; P<0.00001). The reductions in stent thrombosis were observed in (i) early stent thrombosis (within 30 days) (0.2% versus 0.9%; OR: 0.24; P=0.0005), (ii) late (day 31–365) (0.2% versus 0.6%; OR: 0.32; P=0.01), and (iii) very late stent thrombosis (>365 days) (0.2% versus 0.8%; OR: 0.34; P=0.009). The rates of cardiovascular mortality were 1.2% in everolimus group and 1.6% in paclitaxel group (OR: 0.85; P=0.43). Patients receiving everolimus-eluting stents had significantly lower myocardial infarction events and target vessel revascularization as compared to paclitaxel-eluting stents. Interpretation. Everolimus compared to paclitaxel-eluting stents reduced the incidence of early, late, and very late stent thrombosis as well as target vessel revascularization.

scholarly journals The clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Yan Li ◽  
Xiying Liang ◽  
Wenjiao Zhang ◽  
Xuan Qiao ◽  
Zhilu Wang
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Target Vessel Revascularization ◽  
Coronary Syndrome ◽  
No Reflow ◽  
Percutaneous Coronary

Abstract Background Optimal stent deployment is closely related to the prognosis of patients with coronary artery disease, but the effect of post-dilation on clinical and angiographic outcomes in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods PubMed, Embase, The Cochrane Library, Web of Science, CNKI and WANGFANG date-bases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with post-dilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes were comprised of all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, the angiographic outcomes were no reflow and slow reflow. Results A total of 11 studies enrolling 5663 patients met inclusion criteria. Our pooled analysis demonstrated that the post-dilation did not have significant impact on MACE (OR = 0.76, 95% CI 0.50–1.17; P = 0.21), stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P = 0.24), myocardial infarction (OR = 0.14, 95% CI 0.51–3.83; P = 0.51), and target vessel revascularization of clinical outcomes (OR = 0.61, 95% CI 0.21–1.80; P = 0.37) between post-dilation and non-post-dilation groups, but increased the risk of all-cause death (OR = 1.49, 95% CI 1.05–2.19; P = 0.03). There were no significant difference in no reflow (OR = 1.19, 95% CI 0.54–2.65; P = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; P = 0.24) of angiographic outcomes between two groups. Conclusions The post-dilation can increase the risk of all-cause death, without affecting the risks of MACE, stent thrombosis, myocardial infarction, target vessel revascularization, no reflow and slow reflow. However, more randomized controlled trials are required for investigating the benefits of post-dilation for patients with acute coronary syndrome (Registered by PROSPERO, CRD42020160748).

scholarly journals The Clinical and Angiographic Outcomes of Postdilation after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Yan Li ◽  
Xiying Liang ◽  
Wenjiao Zhang ◽  
Xuan Qiao ◽  
Zhilu Wang
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Target Vessel Revascularization ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective. The effect of postdilation in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of postdilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods. PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wangfang databases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with postdilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes comprised all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, and the angiographic outcomes were no reflow and slow reflow. Results. 11 studies met inclusion criteria. In clinical outcomes, our pooled analysis demonstrated that the postdilation had a tendency of decreasing MACE (OR = 0.67, 95% CI 0.45–1.00; P  = 0.05) but significantly increased all-cause death (OR = 1.49, 95% CI 1.05–2.12; P  = 0.03). No significant difference existed in stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P  = 0.24), myocardial infarction (OR = 1.40, 95% CI 0.51–3.83; P  = 0.51), and target vessel revascularization (OR = 0.61, 95% CI 0.21–1.80; P  = 0.37) between postdilation and non-postdilation groups. In angiographic outcomes, there were no significant differences in no reflow (OR = 1.19, 95% CI 0.54–2.65; P  = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; P  = 0.24) between two groups. Conclusions. The postdilation tends to reduce the risk of MACE but significantly increases all-cause death, without significantly affecting stent thrombosis, myocardial infarction, target vessel revascularization, and coronary TIMI flow grade. However, more randomized controlled trials are required for investigating the effect of postdilation for patients with acute coronary syndrome (registered by PROSPERO, CRD42020160748).

scholarly journals A meta-analysis of everolimus-eluting stents versus sirolimus-eluting stents and paclitaxel-eluting stents in diabetic patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hang Ouyang ◽  
Xuehui Zeng ◽  
Chunlei Zhang ◽  
Linli Song ◽  
Jiarui Xu ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Diabetic Patients ◽  
Controlled Trials ◽  
Target Vessel ◽  
Target Vessel Revascularization ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
Late Luminal Loss

Abstract Objective We performed this meta-analysis to determine which stent among everolimus eluting stents (EES), sirolimus eluting stents (SES) and paclitaxel eluting stents (PES) should be preferred for the treatment of DM patients. Methods A systematic search of publications about randomized controlled trials (RCTs) focused on diabetic patients received EES, SES or PES was conducted. We evaluated the following indicators: target vessel revascularization (TVR), target lesion revascularization (TLR), late luminal loss (LLL), stent thrombosis (ST), myocardial infarction (MI), all-cause mortality and cardiac mortality. Results EES showed obvious advantages over SES for DM patients, as it induced the lowest rate of target vessel revascularization and target lesion revascularization (TLR) (p = 0.04). In addition, EES induced lower in-segment LLL than PSE and SES and lower in-stent LLL than PES in DM patients (all p < 0.05). Moreover, EES effectively reduced all-cause mortality compared to SES (RR = 0.71, 95% CI: 0.52–0.99, p = 0.04) and MI rates compared to PES (RR = 0.44, 95% CI: 0.26–0.73, p = 0.0002). Furthermore, EES could reduce the ST rate compared with both SES (RR = 0.53, 95% CI: 0.28–0.98, p = 0.04) and PES (RR = 0.18, 95% CI: 0.07–0.51, p = 0.001). Conclusion Among those three types of stents, EES should be the first recommended stent for DM patients.

Effect of ticagrelor monotherapy on mortality after percutaneous coronary intervention: a systematic review and meta-analysis of randomized trials including 26 143 patients

2020 ◽  
Author(s):  
Sung-Jin Hong ◽  
Chul-Min Ahn ◽  
Jung-Sun Kim ◽  
Byeong-Keuk Kim ◽  
Young-Guk Ko ◽  
...  
Keyword(s):  
Conventional Therapy ◽  
Randomized Trials ◽  
Therapy Group ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Short Term ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Conventional Therapy Group ◽  
Type 3

Abstract Aims Optimal timing and strategy of antiplatelet monotherapy after dual-antiplatelet therapy (DAPT) consisting of aspirin and P2Y12 inhibitor for patients who underwent percutaneous coronary intervention (PCI) is still being debated. The aim of this study was to evaluate the effect of ticagrelor monotherapy after short-term DAPT after PCI on mortality. Methods and results A systematic review and meta-analysis was performed using PubMed to search for ticagrelor monotherapy after short-term DAPT comparing conventional DAPT in patients who underwent PCI. Three randomized trials encompassing 26 143 patients [ticagrelor monotherapy after 1–3 months of DAPT (n = 13 062) vs. conventional therapy (n = 13 081)] were included. The efficacy endpoint of all-cause mortality was significantly lower with the ticagrelor monotherapy group vs. the conventional therapy group [risk ratio (RR) = 0.80, 95% confidence interval (CI) 0.65–0.98; P = 0.03; I2 = 0%; number needed to treat for benefit (NNTB) = 320]. The safety endpoint of Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding was also significantly lower with the ticagrelor monotherapy group vs. the conventional therapy group (RR = 0.67, 95% CI 0.49–0.92; P = 0.01; I2 = 65%; NNTB = 156). There were no significant differences in ischaemic stroke, acute myocardial infarction, and stent thrombosis. The favourable effects of the ticagrelor monotherapy vs. the conventional therapy on all-cause mortality and BARC type 3 or 5 bleeding were consistent in the subset of patients presenting acute coronary syndromes (n = 15 157). Conclusion Ticagrelor monotherapy after short-term DAPT of 1–3 months was associated with decreased all-cause mortality and BARC type 3 or 5 bleeding not offset by increase of cardiac death, ischaemic stroke, acute myocardial infarction, and stent thrombosis.

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