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  • Time-to-Event Meta-Analysis - Time to Do it Right!

    Complete versus culprit-only revascularization in patients presenting with ST-elevation myocardial infarction (STEMI) with multivessel disease is a subject of ongoing debate and clinical trials, a majority of which are underpowered or not definitive with respect to the time of complete revascularization. In this issue, Al-Abdouh et al. published a meta-analysis comparing complete revascularization vs. culprit-only revascularization in patients with STEMI and multivessel disease. A total of 12 randomized trials, with 7592 patients, were included in their analysis. The authors demonstrated that there was a significantly lower risk of major adverse cardiac events (hazard ratio [HR] 0.61; 95% confidence interval [CI] 0.43-0.60; p = 0.0009; I 2 = 72%), cardiovascular mortality (HR 0.74; 95% CI 0.56-0.99]; p = 0.04; I 2 = 2%), and repeat revascularization (HR 0.43; 95% CI 0.31-0.59; p < 0.00001; I 2 = 67%) in patients treated with complete revascularization in comparison with culprit-only revascularization. For this time-to-event data analysis, the authors calculated hazard ratios by indirect methods, in the studies where hazard ratios were not reported, instead of using event number and total number of patients. The authors should be applauded for performing calculated hazard ratios rather than using a dichotomous variable-based analysis.

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