Abstract 15579: Multivessel Coronary Artery Revascularization During Index Hospitalization Has Favorable Outcomes Compared to Infarct Related Artery Only Revascularization in STEMI Patients- Meta-Analysis of Randomized Control Trials

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sainath Gaddam ◽  
Viswajit Reddy Anugu ◽  
Deepak Asti ◽  
Muhammad Raza ◽  
Bhavi Pandya ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Complete Revascularization ◽  
Randomized Control Trials ◽  
Primary Pci ◽  
Index Hospitalization ◽  
Repeat Revascularization ◽  
Number Of Patients ◽  
Randomized Control

Introduction: Multivessel coronary artery disease is present in about half of the patients presenting with STEMI. Timing of revascularization for the non-culprit vessels has been a long debate, with few trials suggesting benefit at index hospitalization rather than staging them at a later time. Current ACCF/AHA 2013 STEMI guidelines do not recommend PCI of non-infarct artery at the time of primary PCI but recommend it at a later time if patients are symptomatic. We hypothesized, complete revascularization during primary PCI or index hospitalization would have favorable outcomes compared to culprit vessel only revascularization. Aim: We performed meta-analysis of randomized control trials comparing multivessel vs. infarct artery only revascularization during primary PCI or index hospitalization. Methods and Results: Pubmed, Embace and Google scholar databases were searched for randomized control trials comparing multivessel vs. culprit vessel only revascularization during primary PCI or index hospitalization. We compared deaths, non-fatal MI and repeat revascularization events for the groups. Total number of patients in our study was 1819, with 919 patients in multivessel revascularization and 900 patients in infarct artery only revascularization groups. Mean follow up period was 28 months. Pooled analysis showed significant favorability for multivessel coronary revascularization comparing events of repeat revascularization (OR= 0.39, p<0.0001). There was also non-significant decrease in mortality (OR=0.92, p=0.7) and non-fatal MI (OR=0.68, p=0.09) with complete revascularization. Conclusions: In our study of STEMI patients, complete revascularization during primary PCI or index hospitalization has significantly decreased need for repeat revascularization and there was also non-significant decrease in mortality and non-fatal MI. Studies with larger sample size and longer follow up are needed for stronger evidence.

scholarly journals Surgical and percutaneous revascularization outcomes based on SYNTAX I, II, and residual scores: a long-term follow-up study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Eduardo Bello Martins ◽  
Whady Hueb ◽  
David L. Brown ◽  
Thiago Luis Scudeler ◽  
Eduardo Gomes Lima ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Complete Revascularization ◽  
Repeat Revascularization ◽  
Long Term Follow Up

Abstract Background The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up. Methods This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE. Results In the CABG sample, SSI had a median of 23 (IQR 17–29.5), median SSII of 25.4 (IQR 19.2–32.8), and median rSS of 2 (IQR 0–6.5); in PCI SSI had a median of 14 (IQR 10–19.1), median SSII of 28.7 (IQR 23–34.2), and median rSS of 4.7 (IQR 0–9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13–3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74–10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01–1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function. Conclusion Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis.

scholarly journals Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204062232199027
Author(s):  
Kongyong Cui ◽  
Hong Liu ◽  
Fei Yuan ◽  
Feng Xu ◽  
Min Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Repeat Revascularization ◽  
Artery Disease

Background: The relative role of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stent implantation in patients with chronic kidney disease (CKD) and complex coronary artery disease (CAD) remains debatable due to the lack of randomized controlled trials (RCTs). We therefore performed this meta-analysis to compare the outcomes of the two strategies in CKD patients with multivessel and/or left main disease. Methods: Electronic databases including PubMed, EMBASE and Cochrane Library were comprehensively searched to identify the eligible subgroup analysis of RCTs and propensity-matched registries. The primary endpoint was all-cause mortality during the longest follow-up. Results: Five subgroup analyses of RCTs and six propensity-matched registries involving 26,441 patients were analyzed. Overall, the strategy of CABG was associated with lower risks of long-term mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.74–0.93], myocardial infarction (OR, 0.41; 95% CI, 0.27–0.62), and repeat revascularization (OR, 0.25; 95% CI, 0.16–0.39) compared with PCI in CKD patients with complex CAD. However, CABG was slightly associated with higher risk of stroke than PCI (OR, 1.33; 95% CI, 1.00–1.77). Nonetheless, the higher stroke risk in the CABG group no longer existed during long-term follow-up (OR, 0.92; 95% CI, 0.37–2.25) (>3 years). Conclusion: This meta-analysis supports the current guideline advising CABG for patients with CKD and complex CAD. At the expense of slightly increased risk of stroke, CABG reduces the incidences of long-term all-cause death, myocardial infarction and repeat revascularization compared with PCI.

scholarly journals Surgical and Percutaneous Revascularization Outcomes based on SYNTAX I, II, and Residual Scores. A Long-Term follow-up Study.

2021 ◽  
Author(s):  
Eduardo Bello Martins ◽  
Whady Hueb ◽  
David L Brown ◽  
Thiago Luis Scudeler ◽  
Eduardo Gomes Lima ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Complete Revascularization ◽  
Repeat Revascularization ◽  
Long Term Follow Up

Abstract BackgroundThe objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up.MethodsThis is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction (MI), stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE.ResultsIn the CABG sample, SSI had a median of 23 (IQR:17-29.5), median SSII of 25.4 (IQR:19.2-32.8), and median rSS of 2 (IQR:0-6.5); in PCI SSI had a median of 14 (IQR:10-19.1), median SSII of 28.7 (IQR:23-34.2), and median rSS of 4.7 (IQR:0-9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% versus 21.2%; adjusted HR: 1.98; 95% CI, 1.13-3.47; P=.016) and repeat revascularization (3.8% versus 11.5%; adjusted HR: 4.35; CI 95%: 1.74-10.85; P=.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR=1.04; 95% CI, 1.01-1.06; P=.001). Regarding death, the only independent predictors were ejection fraction and renal function.ConclusionSurgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis.

EXPRESS: Comparison of Mothership versus Drip-and-Ship Models in treating patients with Acute Ischemic Stroke: A systematic review and meta-analysis

2021 ◽  
pp. 174749302110132
Author(s):  
Ahmed Mohamed ◽  
Nida Fatima ◽  
Ashfaq Shuaib ◽  
Maher Saqqur
Keyword(s):  
Functional Outcome ◽  
Meta Analysis ◽  
Critical Time ◽  
Functional Independence ◽  
Models Of Care ◽  
Randomized Control Trials ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
The Mean ◽  
Randomized Control

Introduction There is controversy if direct to comprehensive center “mothership” (MS) or stopping at primary center for thrombolysis before transfer to comprehensive center “drip-and- ship” (DS) are best models of treatment of acute stroke. In this study, we compare MS and DS models to evaluate the best option of functional outcome. Methods Studies between 1990 and 2020 were extracted from online electronic databases. We compared the clinical outcomes, critical time measurements, functional independence and mortality were then compared. Results A total of 7,824 patients’ data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). 4,639 (59.3%) patients were treated under MS model and 3,185 (40.7%) followed the DS model with mean age of 70.01±3.58 vs. 69.03±3.36; p< 0 .001, respectively. The National Institute Health Stroke Scale was 15.57±3.83 for the MS and 15.72±2.99 for the DS model (p=<0.001). The mean symptoms onset-to-puncture time was significantly shorter in the MS group compared to the DS (159.69 min vs. 223.89 min; p=<0.001, respectively). Moreover, the collected data indicated no significant difference between symptom’s onset to intravenous (IV) thrombolysis time and stroke onset-to-successful recanalization time (p=0.205 and p=<0.001, respectively). Patients had significantly worse functional outcome [modified rankin score (mRS)] (3-6) at 90-days in the DS model [Odds Ratio (OR): 1.47, 95% Confidence Interval (CI): 1.13-1.92, p<0.004] and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95%CI: 1.22-1.81, p<0.0001) compared to MS. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95%CI: 0.87-1.55, p=0.32) and successful recanalization (OR: 1.12, 95%CI: 0.76-1.65, p=0.56) between the two models of care. Conclusion Patients in the MS model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies is not of sufficient quality to make definite recommendations.

P957Survival benefits of routine glycoprotein IIb/IIIa inhibitors during primary PCI in ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Karathanos ◽  
Y F Lin ◽  
L Dannenberg ◽  
C Parco ◽  
V Schulze ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Repeat Revascularization ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Randomised Controlled

Abstract Background Cardiovascular guidelines recommend adjunct glycoprotein IIb/IIIa inhibitors (GPI) only in selected patients with acute ST-segment elevation myocardial infarction (STEMI). Purpose This study aimed to evaluate routine GPI use in STEMI treated with primary PCI. Methods Online databases were systematically searched for randomised controlled trials (RCTs) of routine GPI vs. control therapy in STEMI. Data from retrieved studies were abstracted and evaluated in a comprehensive meta-analysis using Mantel-Haenszel estimates of risk ratios (RR) as summary statistics. Results After systematic review, twenty-one RCTs with 8,585 patients were included: ten trials randomized tirofiban (T), nine abciximab (A), one eptifibatide (E), one trial used A+T; only one trial used DAPT with prasugrel/ ticagrelor. Routine GPI were associated with a significant reduction in all-cause mortality at 30 days (2.4% (GPI) vs. 3.2%; risk ratio (RR) 0.72; p=0.01) and 6 months (3.7% vs. 4.8%; RR 0.76; p=0.02), and a reduction in recurrent MI (1.1% vs. 2.1%; RR 0.55; p=0.0006), repeat revascularization (2.5% vs. 4.1%; RR 0.63; p=0.0001), TIMI flow <3 after PCI (5.4% vs. 8.2%; RR 0.61; p<0.0001) and ischemic stroke (RR 0.42; p=0.04). Major (4.7% vs. 3.4%; RR 1.35; p=0.005) and minor bleedings (7.2% vs. 5.1%; RR 1.39; p=0.006) but not intracranial bleedings (0.1% vs. 0%; RR 2.7; p=0.37) were significantly increased under routine GPI. Conclusions Routine GPI administration during primary PCI in STEMI resulted in mortality reduction, driven by reductions in recurrent ischemic events – however predominantly in trials pre-prasugrel/ticagrelor. Trials in contemporary STEMI management are needed to confirm these findings.

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