Abstract 16721: A Meta-Analysis of Early versus Delayed Revascularization Among Patients With Non-st-segment Elevation Myocardial Infarction

Introduction: Several randomized control trials (RCTs) have compared early versus delayed coronary revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) and have reported contradicting results. Hypothesis: We performed a meta-analysis of all the available RCTs to date to determine the best strategy in NSTEMI. Methods: We performed a comprehensive search of PubMed, EMBASE, and Cochrane databases for all RCTs comparing an early versus delayed revascularization in NSTEMI. The primary endpoint was all-cause mortality. The secondary endpoints were re-infarction and refractory ischemia. We used the Paule-Mandel (PM) estimator of Tau with Knapp-Hartung adjustment to calculate relative risk (RR) with a 95% confidence interval (CI). Results: Thirteen RCTs were included in the final analysis. The median time between randomization and angiography ranged from 0.5 to 14 h in the early group and 18.3 to 86.0 h in the delayed group. There was no difference in mortality (5.7% vs 6.6%; RR 0.90; 95% CI 0.78-1.04; p = 0.83) (PANEL A) as well as rate of re-infarction (6.7% vs. 7.7%; RR 0.83; 95% CI 0.10-6.71; p = <0.001) (PANEL B) among both the strategy. However, early revascularization was associated with a reduction in refractory ischemia (4.8% vs 7.4%; RR 0.64; 95% CI 0.44-0.94; p=0.002) (PANEL C) Conclusions: Early revascularization for NSTEMI does not reduce the risk of mortality or re-infarction compared with delayed revascularization. Nonetheless, an early invasive approach does decrease the rate of refractory ischemia in NSTEMI.

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Intracoronary Thrombolysis in Patients With ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials

Angiology ◽

10.1177/0003319721995039 ◽

2021 ◽

pp. 000331972199503

Author(s):

Ling Chen ◽

Liye Shi ◽

Wen Tian ◽

Shijie Zhao

Keyword(s):

Myocardial Infarction ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

St Segment Elevation ◽

Myocardial Microcirculation ◽

Segment Elevation Myocardial Infarction ◽

Randomized Controlled ◽

St Segment ◽

Intracoronary Thrombolysis

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.

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

European Heart Journal ◽

10.1093/eurheartj/ehz747.0551 ◽

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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Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

European Heart Journal ◽

10.1093/eurheartj/ehz896 ◽

2019 ◽

Vol 41 (42) ◽

pp. 4103-4110 ◽

Cited By ~ 13

Author(s):

Rita Pavasini ◽

Simone Biscaglia ◽

Emanuele Barbato ◽

Matteo Tebaldi ◽

Dariusz Dudek ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Cardiovascular Death ◽

Multivessel Disease ◽

Complete Revascularization ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Abstract Aims The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and results Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39–0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36–150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55–0.84, I2 = 0% and HR 0.29, 95% CI 0.22–0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37–55) for MI and 8 (95% CI 5–13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56–1.16, I2 = 27%) was not affected by the revascularization strategy. Conclusion In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

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