Efficacy and safety of different revascularization strategies in patients with non-ST-segment elevation myocardial infarction with multivessel disease: a systematic review and network meta-analysis.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Postepy W Kardiologii Interwencyjnej Pub Date : 2024-12-01 Epub Date: 2024-11-05 DOI:10.5114/aic.2024.144666

Tingting Chen, Chen Lu, Jingli Mo, Ting Wang, Xiang Li, Ying Yang

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引用次数: 0

Abstract

Introduction: The optimal timing of revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease (MVD) remains controversial.

Aim: We investigated the impact of different revascularization strategies on clinical outcomes to assess the optimal revascularization strategy for these patients.

Methods: We performed a network meta-analysis of cohort studies comparing revascularization strategies in NSTEMI with MVD. Effect sizes were calculated as odds ratios (ORs) using a random-effects model. The primary efficacy outcome was all-cause mortality and the primary safety outcome was recurrent myocardial infarction.

Results: Eight eligible studies involving 34,151 patients receiving four revascularization strategies were analyzed. Compared to conventional culprit-only revascularization (COR), planned complete multi-vessel percutaneous coronary intervention during a second hospitalization (MV-PCI) reduced the risk of major adverse cardiovascular events (MACEs) (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.38-0.74) and decreased all-cause mortality (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.30-0.93) and the likelihood of repeat revascularization (MV-PCI vs. COR: OR = 0.55; 95% CI: 0.37-0.82). However, compared to COR, immediate complete revascularization (ICR) but not MV-PCI was associated with reduced risk of recurrent MI (COR vs. ICR: OR = 1.39; 95% CI: 1.07-1.81; MV-PCI vs. COR: OR = 0.64; 95% CI: 0.40-1.01). Compared to MV-PCI: COR and staged complete revascularization during index PCI (SCR) increased the risk of cardiovascular mortality (MV-PCI vs. COR: OR = 0.48; 95% CI: 0.34-0.70; MV-PCI vs. SCR: OR = 0.62; 95% CI: 0.40-0.96). COR also had significantly higher cardiovascular mortality compared to ICR (COR vs. ICR: OR = 1.38; 95% CI: 1.02-1.85).

Conclusions: Complete revascularization is more effective compared to culprit-only revascularization for most follow-ups.

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来源期刊

Postepy W Kardiologii Interwencyjnej 医学-心血管系统

CiteScore

1.60

自引率

15.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Postępy w Kardiologii Interwencyjnej/Advances in Interventional Cardiology is indexed in: Index Copernicus, Ministry of Science and Higher Education Index (MNiSW). Advances in Interventional Cardiology is a quarterly aimed at specialists, mainly at cardiologists and cardiosurgeons. Official journal of the Association on Cardiovascular Interventions of the Polish Cardiac Society.