• Network Meta-Analysis of Percutaneous Intervention-Based Revascularization Strategies for ST-Elevation Myocardial Infarction and Concomitant Multi-Vessel Disease

    Highlights

    • Approximately 40%–50% patients with ST-elevation myocardial infarction (STEMI) have multi-vessel disease (MVD) that portends worse prognosis.
    • This network meta-analysis (NMA) compares the effect of different revascularization strategies in stable patients with STEMI and MVD.
    • Instant complete revascularization (CR-I) was associated with 40% reduction in all cause mortality compared to (infarct artery revascularization) IRA.
    • Probability analysis ranked CR-I as the best intervention for decreasing mortality.
    • In sensitivity analysis CR-1 was superior to IRA in reducing mortality.

    Abstract

    Background

    In patients with ST elevation myocardial infarction (STEMI) and concomitant multi-vessel disease (MVD), primary percutaneous coronary intervention (PCI) of the culprit vessel is the preferred reperfusion strategy. However, optimum timing of revascularization for non-culprit artery is unclear. In this Bayesian network meta-analysis (NMA), we compared different PCI-based revascularization strategies in STEMI patients with MVD.

    Methods

    11 randomized controlled trials (RCTs) were selected using MEDLINE, EMBASE and CENTRAL (Inception to September 2017). For all outcomes, median estimate of odds ratio from posterior distribution with corresponding 95% credible interval was calculated. The Surface under the Cumulative Ranking Curve (SUCRA) metric was used to estimate the relative ranking probability of each intervention. Sensitivity analysis was conducted by excluding the RCTs in which the staged intervention was performed after two weeks of the index procedure or post discharge.

    Results

    In this NMA of 3172 patients, CR-I (instant complete revascularization) was associated with 40% relative risk reduction in all-cause mortality compared with IRA (infarct related artery) [0.60 (0.31–0.89)]. CR-I was superior to CR-S (staged complete revascularization) [0.42 (0.22–0.70)] and IRA [0.50(0.29–0.72)] in reducing the risk of re- infarction. Both CR-I and CR-S significantly reduced the risk of repeat revascularization compared to IRA, whereas the risk of CIN (contrast induced nephropathy) and major bleeding was similar across all interventions. Sensitivity analysis showed, that CR-I was a better strategy compared with CR-S [0.34 (0.12–0.74)] and IRA (0.60 [0.36–0.97]) in reducing all-cause mortality.

    Conclusions

    In this NMA, CR-I was associated with reduction in all-cause mortality and re- infarction compared with IRA.

    Author bio

    Cardiovascular Revascularization Medicine, 2019-07-01, Volume 20, Issue 7, Pages 603-611, Copyright © 2018 Elsevier Inc.

     

    Source:

    Read the full article on Science Direct: Network Meta-Analysis of Percutaneous Intervention-Based Revascularization Strategies for ST-Elevation Myocardial Infarction and Concomitant Multi-Vessel Disease

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