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The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials

BACKGROUND: The optimal timing of revascularization in unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI) remains uncertain. We compared routine early revascularization (REV) versus selective late revascularization (SLR) strategies and divergence in the approach of cardi...

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Autores principales: Virk, Hafeez Ul Hassan, Lo, Kevin Bryan, Krittanawong, Chayakrit, Inayat, Faisal, Sarwar, Usman, Ghani, Ali Raza, Witzke, Christian, Janzer, Sean, George, Jon C., Pressman, Gregg, Bozorgnia, Behnam, Chatterjee, Saurav, Figueredo, Vincent M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225861/
https://www.ncbi.nlm.nih.gov/pubmed/30425758
http://dx.doi.org/10.14740/jocmr3585w
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author Virk, Hafeez Ul Hassan
Lo, Kevin Bryan
Krittanawong, Chayakrit
Inayat, Faisal
Sarwar, Usman
Ghani, Ali Raza
Witzke, Christian
Janzer, Sean
George, Jon C.
Pressman, Gregg
Bozorgnia, Behnam
Chatterjee, Saurav
Figueredo, Vincent M.
author_facet Virk, Hafeez Ul Hassan
Lo, Kevin Bryan
Krittanawong, Chayakrit
Inayat, Faisal
Sarwar, Usman
Ghani, Ali Raza
Witzke, Christian
Janzer, Sean
George, Jon C.
Pressman, Gregg
Bozorgnia, Behnam
Chatterjee, Saurav
Figueredo, Vincent M.
author_sort Virk, Hafeez Ul Hassan
collection PubMed
description BACKGROUND: The optimal timing of revascularization in unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI) remains uncertain. We compared routine early revascularization (REV) versus selective late revascularization (SLR) strategies and divergence in the approach of cardiologists in the United States and Europe. METHODS: Seventeen randomized controlled trials (RCTs) (15,812 patients) were extracted from PubMed, Cochrane Library, EMBASE and Web of Science databases. The data were pooled using the Der Simonian and Laird random-effect models and expressed as pooled risk ratios (RR) with 95% confidence intervals (95% CIs). RESULTS: Overall, there was no difference in all-cause mortality (RR: 1.01, 95% CI: 0.95 - 1.08, P = 0.7), myocardial infarction (MI) (RR: 0.98, 95% CI: 0.79 - 1.22, P = 0.85) or coronary artery bypass grafting (CABG) (RR: 1.33, 95% CI: 0.92 - 1.91, P = 0.12) between REV and SLR strategy. There were trends of decreased incidence of MI in REV, 13.3% (1,029/7,704) vs. 15.1% (1,108/7,314) in SLR (P = 0.007), and rate of CABG was higher in REV, 4.9% (140/2,831) vs. 3.7% (105/2,819) in SLR (P = 0.031). There were trends of lower all-cause mortality in the combined US/international trials in both REV 8.4% (390/4,624) vs. 22.8% (908/3,975) (P < 0.001) and SLR 8% (359/4,421) vs. 24% (910/3,808) (P < 0.001) compared to the European trials. There were also trends of lower rates of MI in the European trials in the REV group 20% (623/3,080) vs. 25% (712/2,893) in SLR (P = 0.001) and higher rates of CABG in REV 8.3% (96/1,144) vs. 5.7% (67/1,165) in SLR (P = 0.02); however, there were no significant effects in the pooled RR ratios even after subgroup analysis between US/international trials and European trials. CONCLUSIONS: Despite having contemporary differences in the management approach towards UA/NSTEMI patients, no significant differences in trends were observed with REV strategy in US/international trials vs. European trials.
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spelling pubmed-62258612018-11-13 The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials Virk, Hafeez Ul Hassan Lo, Kevin Bryan Krittanawong, Chayakrit Inayat, Faisal Sarwar, Usman Ghani, Ali Raza Witzke, Christian Janzer, Sean George, Jon C. Pressman, Gregg Bozorgnia, Behnam Chatterjee, Saurav Figueredo, Vincent M. J Clin Med Res Original Article BACKGROUND: The optimal timing of revascularization in unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI) remains uncertain. We compared routine early revascularization (REV) versus selective late revascularization (SLR) strategies and divergence in the approach of cardiologists in the United States and Europe. METHODS: Seventeen randomized controlled trials (RCTs) (15,812 patients) were extracted from PubMed, Cochrane Library, EMBASE and Web of Science databases. The data were pooled using the Der Simonian and Laird random-effect models and expressed as pooled risk ratios (RR) with 95% confidence intervals (95% CIs). RESULTS: Overall, there was no difference in all-cause mortality (RR: 1.01, 95% CI: 0.95 - 1.08, P = 0.7), myocardial infarction (MI) (RR: 0.98, 95% CI: 0.79 - 1.22, P = 0.85) or coronary artery bypass grafting (CABG) (RR: 1.33, 95% CI: 0.92 - 1.91, P = 0.12) between REV and SLR strategy. There were trends of decreased incidence of MI in REV, 13.3% (1,029/7,704) vs. 15.1% (1,108/7,314) in SLR (P = 0.007), and rate of CABG was higher in REV, 4.9% (140/2,831) vs. 3.7% (105/2,819) in SLR (P = 0.031). There were trends of lower all-cause mortality in the combined US/international trials in both REV 8.4% (390/4,624) vs. 22.8% (908/3,975) (P < 0.001) and SLR 8% (359/4,421) vs. 24% (910/3,808) (P < 0.001) compared to the European trials. There were also trends of lower rates of MI in the European trials in the REV group 20% (623/3,080) vs. 25% (712/2,893) in SLR (P = 0.001) and higher rates of CABG in REV 8.3% (96/1,144) vs. 5.7% (67/1,165) in SLR (P = 0.02); however, there were no significant effects in the pooled RR ratios even after subgroup analysis between US/international trials and European trials. CONCLUSIONS: Despite having contemporary differences in the management approach towards UA/NSTEMI patients, no significant differences in trends were observed with REV strategy in US/international trials vs. European trials. Elmer Press 2018-12 2018-10-30 /pmc/articles/PMC6225861/ /pubmed/30425758 http://dx.doi.org/10.14740/jocmr3585w Text en Copyright 2018, Virk et al. http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Virk, Hafeez Ul Hassan
Lo, Kevin Bryan
Krittanawong, Chayakrit
Inayat, Faisal
Sarwar, Usman
Ghani, Ali Raza
Witzke, Christian
Janzer, Sean
George, Jon C.
Pressman, Gregg
Bozorgnia, Behnam
Chatterjee, Saurav
Figueredo, Vincent M.
The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials
title The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials
title_full The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials
title_fullStr The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials
title_full_unstemmed The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials
title_short The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials
title_sort effects of geography on outcomes of routine early versus selective late revascularization strategy in the treatment of unstable angina and non-st-segment elevation myocardial infarction: a meta-analysis of transatlantic randomized controlled trials
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225861/
https://www.ncbi.nlm.nih.gov/pubmed/30425758
http://dx.doi.org/10.14740/jocmr3585w
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