04377nam a22006617a 4500
180619s20182018 xxu||||| |||| 00| 0 eng d
1569-5794
10.1007/s10554-018-1362-9 [doi]
10.1007/s10554-018-1362-9 [pii]
Ovid MEDLINE(R)
29779179
Clinical outcomes of complete revascularization using either angiography-guided or fractional flow reserve-guided drug-eluting stent implantation in non-culprit vessels in ST elevation myocardial infarction patients: insights from a study based on a systematic review and meta-analysis. [Review]
The International Journal of Cardiovascular Imaging. 34(9):1349-1364, 2018 Sep.
Int J Cardiovasc Imaging. 34(9):1349-1364, 2018 Sep.
The international journal of cardiovascular imaging
2018
FY2019
2018-06-19
FY2018
Current guidelines recommend that percutaneous coronary intervention (PCI) should be restricted to the culprit vessel in ST elevation myocardial infarction (STEMI) patients with multi-vessel disease (MVD) and without cardiogenic shock. However, newer data suggests that performing complete revascularization (CR) in MVD patients may lead to better outcomes compared to intervention in the culprit vessel only. The aim of this meta-analysis is to examine the available data to determine if CR (using either angio- or fractional flow reserve guidance-FFR) following primary PCI in STEMI patients without cardiogenic shock impacts clinical outcomes. Meta-analysis was performed by conducting a literature search of PubMed from January 2004 to July 2017. Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated using random-effect models. A total of 9 studies (3317 patients) were included. CR showed a significant MACE reduction (OR 0.49, 95% CI 0.36-0.66, p<0.001); All-cause mortality (OR 0.69, 95% CI 0.48-0.98, p=0.04) and repeat revascularization (OR 0.38, 95% CI 0.28-0.51, p<0.001) at>=12 months follow-up. The FFR-guiding CR group presented a MACE reduction (odds ratio 0.52, 95% CI 0.30-0.90, p=0.02) due to a decrease of repeat revascularization (OR 0.41, 95% CI 0.21-0.80, p=0.009). Overall, performing complete revascularization in STEMI patients showed a MACE reduction, all-cause death and repeat revascularization. Compared to culprit-only revascularization, treating multi-vessel disease in STEMI patients using FFR guidance is associated with decreased incidence of MACE, due to a decreased rate of revascularization.
English
*Coronary Artery Disease/th [Therapy]
*Drug-Eluting Stents
*Myocardial Revascularization/mt [Methods]
*Percutaneous Coronary Intervention
*ST Elevation Myocardial Infarction/th [Therapy]
Coronary Angiography
Coronary Artery Disease/co [Complications]
Coronary Artery Disease/dg [Diagnostic Imaging]
Coronary Artery Disease/pp [Physiopathology]
Fractional Flow Reserve, Myocardial
Humans
ST Elevation Myocardial Infarction/dg [Diagnostic Imaging]
ST Elevation Myocardial Infarction/et [Etiology]
ST Elevation Myocardial Infarction/pp [Physiopathology]
Treatment Outcome
MedStar Heart & Vascular Institute
Journal Article
Review
Azizi, Viana
Beyene, Solomon
Brathwaite, Echo J
Dan, Kazuhiro
Desale, Sameer
Dheendsa, Aaphtaab
Garcia-Garcia, Hector M
Hideo-Kajita, Alexandre
Kuku, Kayode
Lipinski, Michael
Meirovich, Yael F
Melaku, Gebremedhin
Ozaki, Yuichi
Soud, Mohammad
Waksman, Ron
Azizi V, Beyene SS, Brathwaite EJ, Dan K, Desale S, Dheendsa A, Garcia-Garcia HM, Hideo-Kajita A, Kuku KO, Lipinski M, Meirovich YF, Melaku GD, Ozaki Y, Soud M, Waksman R
https://dx.doi.org/10.1007/s10554-018-1362-9
https://dx.doi.org/10.1007/s10554-018-1362-9
ART
Article
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0
0
0
Article
authcat
authcat
2018-06-19
0
29779179
29779179
2018-06-19
2018-06-19
ART
3385
3385