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Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis
AIM: The benefit of preventive percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) has been shown in randomised trials. However, all the randomised trials are underpowered to detect benefit in cardiac death. We aim to systematically review evidence on the cardiac m...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189298/ https://www.ncbi.nlm.nih.gov/pubmed/25332779 http://dx.doi.org/10.1136/openhrt-2013-000012 |
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author | Pandit, Anil Aryal, Madan Raj Aryal Pandit, Aashrayata Hakim, Fayaz Ahmad Giri, Smith Mainali, Naba Raj Sharma, Prashant Lee, Howard R Fortuin, F David Mookadam, Farouk |
author_facet | Pandit, Anil Aryal, Madan Raj Aryal Pandit, Aashrayata Hakim, Fayaz Ahmad Giri, Smith Mainali, Naba Raj Sharma, Prashant Lee, Howard R Fortuin, F David Mookadam, Farouk |
author_sort | Pandit, Anil |
collection | PubMed |
description | AIM: The benefit of preventive percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) has been shown in randomised trials. However, all the randomised trials are underpowered to detect benefit in cardiac death. We aim to systematically review evidence on the cardiac mortality benefit of preventive PCI in patients presenting with acute STEMI in randomised patient populations. METHODS: PubMed, Scopus, Cochrane and clinicaltrials.gov databases were searched for studies published until 30 September 2013. The studies were limited to randomised clinical trials. Independent observers abstracted the data on outcomes, characteristics and qualities of studies included. Fixed effect model was employed for meta-analysis. Heterogeneity of studies included was analysed using I(2) statistics. RESULTS: In three randomised clinical trials published, involving 748 patients with acute STEMI and multivessel disease, 416 patients were randomised to preventive PCI and 332 to culprit-only PCI. Patients undergoing preventive PCI had significant lower risk of cardiovascular deaths (pooled OR 0.39, 95% CI 0.18 to 0.83, p=0.01, I(2)=0%), repeat revascularisation (pooled OR 0.28, 95% CI 0.18 to 0.44, p=0.00001, I(2)=0%) and non-fatal myocardial infarction (pooled OR 0.38, 95% CI 0.20 to 0.75, p=0.005, I(2)=0%) compared with culprit-only revascularisation. CONCLUSIONS: In patients presenting with acute STEMI and significant multivessel coronary artery disease, based on our data, preventive PCI is associated with lower risk of cardiovascular mortality compared with primary PCI of only the culprit artery. This finding needs to be confirmed in larger adequately powered randomised clinical trials. |
format | Online Article Text |
id | pubmed-4189298 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-41892982014-10-20 Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis Pandit, Anil Aryal, Madan Raj Aryal Pandit, Aashrayata Hakim, Fayaz Ahmad Giri, Smith Mainali, Naba Raj Sharma, Prashant Lee, Howard R Fortuin, F David Mookadam, Farouk Open Heart Interventional Cardiology AIM: The benefit of preventive percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) has been shown in randomised trials. However, all the randomised trials are underpowered to detect benefit in cardiac death. We aim to systematically review evidence on the cardiac mortality benefit of preventive PCI in patients presenting with acute STEMI in randomised patient populations. METHODS: PubMed, Scopus, Cochrane and clinicaltrials.gov databases were searched for studies published until 30 September 2013. The studies were limited to randomised clinical trials. Independent observers abstracted the data on outcomes, characteristics and qualities of studies included. Fixed effect model was employed for meta-analysis. Heterogeneity of studies included was analysed using I(2) statistics. RESULTS: In three randomised clinical trials published, involving 748 patients with acute STEMI and multivessel disease, 416 patients were randomised to preventive PCI and 332 to culprit-only PCI. Patients undergoing preventive PCI had significant lower risk of cardiovascular deaths (pooled OR 0.39, 95% CI 0.18 to 0.83, p=0.01, I(2)=0%), repeat revascularisation (pooled OR 0.28, 95% CI 0.18 to 0.44, p=0.00001, I(2)=0%) and non-fatal myocardial infarction (pooled OR 0.38, 95% CI 0.20 to 0.75, p=0.005, I(2)=0%) compared with culprit-only revascularisation. CONCLUSIONS: In patients presenting with acute STEMI and significant multivessel coronary artery disease, based on our data, preventive PCI is associated with lower risk of cardiovascular mortality compared with primary PCI of only the culprit artery. This finding needs to be confirmed in larger adequately powered randomised clinical trials. BMJ Publishing Group 2014-02-15 /pmc/articles/PMC4189298/ /pubmed/25332779 http://dx.doi.org/10.1136/openhrt-2013-000012 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/ |
spellingShingle | Interventional Cardiology Pandit, Anil Aryal, Madan Raj Aryal Pandit, Aashrayata Hakim, Fayaz Ahmad Giri, Smith Mainali, Naba Raj Sharma, Prashant Lee, Howard R Fortuin, F David Mookadam, Farouk Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis |
title | Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis |
title_full | Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis |
title_fullStr | Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis |
title_full_unstemmed | Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis |
title_short | Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis |
title_sort | preventive pci versus culprit lesion stenting during primary pci in acute stemi: a systematic review and meta-analysis |
topic | Interventional Cardiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189298/ https://www.ncbi.nlm.nih.gov/pubmed/25332779 http://dx.doi.org/10.1136/openhrt-2013-000012 |
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