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Coronary angiography- or fractional flow reserve-guided complete revascularization in multivessel disease STEMI: A Bayesian hierarchical network meta-analysis.
- Source :
-
International journal of cardiology [Int J Cardiol] 2023 Jan 01; Vol. 370, pp. 122-128. Date of Electronic Publication: 2022 Oct 31. - Publication Year :
- 2023
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Abstract
- Aims: To identify the best strategy to achieve complete revascularization (CR) in patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD).<br />Methods and Results: We systematically reviewed the literature for randomized controlled trials (RCTs) comparing IRA-only PCI and CR guided by angiography or fractional flow reserve (FFR) in MVD-STEMI. Both frequentist (classical) and Bayesian network meta-analysis were performed, including a comparative hierarchy estimation of the probability to reduce the primary composite endpoint of all-cause death and new myocardial infarction (MI). We identified 11 RCTs, including 8193 STEMI patients. Compared with IRA-only strategy, CR significantly reduced the primary endpoint (OR: 0.73; 95%CI0.55-0.97). We observed non-significant difference between angiography and FFR guidance in reducing the primary endpoint (OR: 0.73, 95% CI 0.35-1.57). The Bayesian probability analysis ranked angio-guided CR as the best intervention yielding lowest risk of all-cause death or new MI (SUCRA92%).<br />Conclusions: In patients with MVD-STEMI, CR is associated with a reduction in all-cause mortality and new MI compared with IRA-only PCI. Angio-guided CR is associated with the lowest risk of all-cause death or new MI, therefore the role of FFR-guidance in this setting is questionable.<br />Condensed Abstract: Both frequentist and Bayesian network meta-analysis were performed to compare infarct-related artery (IRA)-only percutaneous coronary intervention (PCI) and complete revascularization (CR) guided by angiography or fractional flow reserve (FFR) in multivessel disease (MVD) and acute ST-elevation myocardial infarction (STEMI). Eleven randomized controlled trials were identified, including 8193 STEMI patients. Compared with IRA-only strategy, CR significantly reduced the incidence of the composite endpoint of all-cause death and new myocardial infarction without significant difference in angio-guided and FFR-guided CR. The Bayesian probability analysis ranked angio-guided CR as the best intervention yielding lowest risk of the composite endpoint and, therefore the role of FFR-guidance in this setting is questionable.<br />Competing Interests: Declaration of Competing Interest None.<br /> (Copyright © 2022 Elsevier B.V. All rights reserved.)
- Subjects :
- Humans
Coronary Angiography
Network Meta-Analysis
Treatment Outcome
ST Elevation Myocardial Infarction diagnostic imaging
ST Elevation Myocardial Infarction surgery
ST Elevation Myocardial Infarction etiology
Fractional Flow Reserve, Myocardial
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease surgery
Percutaneous Coronary Intervention methods
Myocardial Infarction etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 370
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 36328114
- Full Text :
- https://doi.org/10.1016/j.ijcard.2022.10.170