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Optimal Timing of Complete Revascularization in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

Abstract：

BACKGROUND:Studies have suggested that complete revascularization is superior to culprit-only revascularization for the treatment of enzyme-positive acute coronary syndrome. However, the optimal timing of complete revascularization remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials comparing single-stage complete revascularization with multistage percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction with multivessel disease. METHODS AND RESULTS:We systematically searched the Cochrane Central Register of Controlled Trials, Embase, PubMed, and MEDLINE for randomized controlled trials comparing single-stage complete revascularization with multistage revascularization in patients with enzyme-positive acute coronary syndrome. The primary outcome was the incidence of major adverse cardiovascular events at longest follow-up. Data were pooled using DerSimonian and Laird random-effects models. Four randomized controlled trials (n=838) were included in our meta-analysis. The risk of unplanned repeat revascularization at longest follow-up was significantly lower in patients randomized to single-stage complete revascularization (risk ratio, 0.68; 95% CI, 0.47-0.99). Results also suggest a trend towards lower risks of major adverse cardiovascular events for patients randomized to single-stage revascularization at 6 months (risk ratio, 0.67; 95% CI, 0.40-1.11) and at longest follow-up (risk ratio, 0.79; 95% CI, 0.52-1.20). Risks of mortality and recurrent myocardial infarction at longest follow-up were also lower with single-stage revascularization, but 95% CIs were wide and included unity. CONCLUSIONS:Our results suggest that single-stage complete revascularization is safe. There also appears to be a trend towards lower long-term risks of mortality and major adverse cardiovascular events; however, additional randomized controlled trials are required to confirm the potential benefits of single-stage multivessel percutaneous coronary intervention.

journal_name

J Am Heart Assoc

journal_title

Journal of the American Heart Association

authors

Gaffar R,Habib B,Filion KB,Reynier P,Eisenberg MJ

doi

10.1161/JAHA.116.005381

subject

Has Abstract

pub_date

2017-04-10 00:00:00

issue

4

issn

2047-9980

pii

JAHA.116.005381

journal_volume

6

pub_type

杂志文章,meta分析,评审

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