Late Intervention on an Occluded Infarct-Related Artery: A Meta-analysis of the Randomized Controlled Trials

2007 ◽  
Vol 1 ◽  
pp. CMC.S356
Author(s):  
Axel Zagler ◽  
Todd B. Heimowitz ◽  
Esteban Escolar ◽  
Steven J. Hussein ◽  
Zaheer R. Yousef ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Clinical Benefit ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Eligibility Criteria ◽  
Late Intervention ◽  
Infarct Related Artery

Context Late intervention to open an occluded infarct-related artery (IRA) after initial acute myocardial infarction was postulated to lead to clinical benefit. Objective To conduct a meta-analysis of the randomized trials. Study Selection Eligibility criteria were: 1) randomized trials comparing percutaneous coronary intervention (PCI) in a totally occluded artery (TIMI flow 0-1) versus medical therapy, 2) in stable post myocardial infarction (MI) patients without spontaneous or low level exercise induced ischemia, 3) trials with a time from the onset of symptoms to randomization >24 hours, but <6 weeks, and 4) trials reporting mortality and recurrent MI as an endpoint. Of 961 citations reviewed, 3 disagreements were easily resolved by discussion and 6 trials were selected for inclusion. Data Synthesis The primary endpoint was the composite of recurrent MI or death. The secondary endpoints were the development of heart failure or recurrent myocardial infarction. In a meta-analysis of the 6 trials, which included 2642 patients, late intervention of an IRA had a RR of death or recurrent MI of 1.12 (95% CI 0.91-1.38). Data regarding the development of heart failure was available for 4 trials. In a meta-analysis of these 4 trials, which included 2527 patients, late intervention of an IRA had a RR of 0.79 (95% CI 0.58-1.08). Data regarding the occurrence of recurrent MI was available for 5 trials. In a meta-analysis of these 5 trials, which included 2598 patients, late intervention of an IRA had a RR of 1.28 (95% CI 0.91-1.79). Conclusions Our meta-analysis of the currently available randomized data addressing late intervention of an occluded IRA failed to reveal clinical benefit with regard to the clinical endpoints of death, heart failure or reinfarction. The trend towards an increase in reinfarction among the PCI treated patients suggested by the Open Artery Trial (OAT) investigators persisted, but did not achieve statistical significance.

5193Percutaneous coronary intervention provided better result than optimal medical therapy in patients with chronic total occlusion: a metanalysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Khanra ◽  
B Duggal ◽  
I Basu Ray ◽  
B Kumar ◽  
R Walia
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
All Cause Mortality

Abstract Background Studies comparing the outcome of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) versus OMT alone in treatment of chronic total occlusion (CTO) are limited by observational design, variable follow up period, diverse clinical outcome, high drop-out and cross-over rate. Prematurely terminated DECISION CTO trail and the promising result of the most recent EUROCTO trial still left the quest unanswered. Previous metanalysis on the present context were restricted to studies with propensity-matched analysis only and did not incorporate the recent randomized trials. Purpose This study aims to conduct a meta-analysis of published data of observational as well as randomized studies comparing long term outcomes of PCI+OMT versus OMT alone. Methods The present protocol is registered in PROSPERO. PubMed, Embase and Cochrane databases were systematically reviewed. Fourteen studies meeting criteria were included in the meta-analysis. The Cochrane Risk of Bias scale was used to appraise the overall quality of the studies. Revman 5.3 software was used to analyse the data and random-effects model with inverse variance method was undertaken. R packages were used for assessment of bias and metaregression. Results Baseline parameters of both the groups were comparable. Major adverse cardiovascular events (MACE) which comprises of cardiac death, myocardial infarction, stroke, and unplanned revascularization [Figure 1] were significantly lower in the PCI+OMT group. (RR: 0.77; 95% CI: 0.61 to 0.97; P≤0.ehz746.00521; I2=85%). High heterogeneity was partially (14%) explained by age factor. However study design, follow up duration, LVEF, presence of TVD did not attribute significantly to heterogeneity, in isolation or any combination in metregression model. All cause mortality and cardiac death [Figure 2, 3 respectively] were significantly lower in the PCI+OMT group (P=0.29, p=0.63, respectively). Myocardial infarction (P=0.25) and stroke rates (P=0.15) were lower in the PCI+OMT group, however they did not reach statistical significance. Unplanned revascularization (of any vessel) showed a higher trend in the PCI+OMT group, without reaching statistical significance (P=0.46, I2=88%). Conclusion PCI of CTO is rewarded with better long term outcome, in terms of MACE and all-cause mortality but limited to greater unplanned revascularization. Acknowledgement/Funding None

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