Percutaneous coronary revascularization versus medical therapy in chronic coronary syndromes: An updated meta-analysis of randomized controlled trials.

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL European Journal of Clinical Investigation Pub Date : 2024-08-21 DOI:10.1111/eci.14303

Giuseppe Panuccio, Nicole Carabetta, Daniele Torella, Salvatore De Rosa

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Abstract

Introduction: Coronary artery disease (CAD) is a main cause of morbidity and mortality. The effectiveness of coronary revascularization in chronic coronary syndromes (CCS) is still debated. Our recent study showed the superiority of coronary revascularization over optimal medical therapy (OMT) in reducing cardiovascular (CV) mortality and myocardial infarction (MI). The recent publication of the ORBITA-2 trial suggested superiority of percutaneous coronary revascularization (PCI) in reducing angina and improving quality of life. Therefore, we aimed to provide an updated meta-analysis evaluating the impact of PCI on both clinical outcomes and angina in CCS.

Methods: Relevant studies were screened in PubMed/Medline until 08/01/2024. Randomized controlled trials (RCTs) comparing PCI to OMT in CCS were selected. The primary outcome was CV death. Secondary outcomes were MI, all-cause mortality, stroke, major bleeding and angina severity.

Results: Nineteen RCTs involving 8616 patients were included. Median follow-up duration was 3.3 years. Revascularization significantly reduced CV death (4.2% vs. 5.5%; OR = .77; 95% CI .62-.96, p = .02). Subgroup analyses favoured revascularization in patients without chronic total occlusions (CTOs) (p = .052) and those aged <65 years (p = .02). Finally, a follow-up duration beyond 3 years showed increased benefit of coronary revascularization (p = .04). Secondary outcomes analyses showed no significant differences, except for a lower angina severity in the revascularization group according to the Seattle Angina Questionnaire (SAQ) (p = .04) and to the Canadian Cardiovascular Society (CCS) classification (p = .005).

Conclusions: PCI compared to OMT significantly reduces CV mortality and angina severity, improving quality of life in CCS patients. This benefit was larger without CTOs, in patients aged <65 years and with follow-up duration beyond 3 years.

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慢性冠状动脉综合征经皮冠状动脉血运重建与药物治疗的比较：随机对照试验的最新荟萃分析。

简介：冠状动脉疾病（CAD）是发病和死亡的主要原因：冠状动脉疾病（CAD）是发病和死亡的主要原因。冠状动脉血运重建对慢性冠状动脉综合征（CCS）的疗效仍存在争议。我们最近的研究表明，在降低心血管疾病（CV）死亡率和心肌梗死（MI）方面，冠状动脉血运重建优于最佳药物治疗（OMT）。最近发表的 ORBITA-2 试验表明，经皮冠状动脉血运重建（PCI）在减少心绞痛和改善生活质量方面更具优势。因此，我们旨在提供最新的荟萃分析，评估经皮冠状动脉再通术对慢性心肌梗死患者临床预后和心绞痛的影响：方法：在PubMed/Medline上筛选了截至2024年1月8日的相关研究。方法：在PubMed/Medline上筛选了截至2024年1月8日的相关研究，并选择了在CCS中比较PCI和OMT的随机对照试验（RCT）。主要结果为冠心病死亡。次要结果为心肌梗死、全因死亡率、中风、大出血和心绞痛严重程度：结果：共纳入19项RCT，涉及8616名患者。中位随访时间为 3.3 年。血管重建大大降低了心血管疾病的死亡率（4.2% vs. 5.5%；OR = .77；95% CI .62-.96，P = .02）。亚组分析结果显示，无慢性全闭塞（CTO）的患者（p = .052）和年龄较大的患者更倾向于接受血管重建术：与 OMT 相比，PCI 能明显降低 CCS 患者的 CV 死亡率和心绞痛严重程度，改善生活质量。在没有 CTO 的情况下，这种益处在年龄较大的患者中更大。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.