Back to Search Start Over

Clinical impact of coronary revascularization over medical treatment in chronic coronary syndromes: A systematic review and meta-analysis.

Authors :
Panuccio G
Carabetta N
Torella D
De Rosa S
Source :
Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese [Hellenic J Cardiol] 2024 Jul-Aug; Vol. 78, pp. 60-71. Date of Electronic Publication: 2023 Nov 08.
Publication Year :
2024

Abstract

Objective: To provide a quantitative comparison between myocardial revascularization (REVASC) and optimal medical treatment (OMT) alone in patients with chronic coronary syndrome (CCS).<br />Methods: Pertinent studies were searched for in PubMed/Medline until 12/03/2023. Randomized controlled trials that compare REVASC to OMT reporting clinical outcomes were selected according to PRISMA guidelines. The primary outcome was cardiovascular death. Two investigators independently assessed the study quality and extracted data.<br />Results: Twenty-eight randomized controlled studies (RCTs) including 20692 patients were included in this meta-analysis. The rate of cardiovascular mortality was significantly lower among patients treated with myocardial revascularization [risk ratio (RR) 0.79, 95% CI 0.69-0.90]. Age (p = 0.03), multivessel disease (p < 0.001), and follow-up duration (p = 0.001) were significant moderators of CV mortality. Subgroup analyses showed a larger benefit in patients treated with drug-eluting stents and those without chronic total occlusion. Among secondary outcomes, myocardial infarction was less frequent in the REVASC group (RR = 0.74; p < 0.001), while no significant difference was found for all-cause mortality (p = 0.09) nor stroke (p = 0.26).<br />Conclusions: The present analysis showed lower rates of CV mortality and myocardial infarction in CCS patients treated with myocardial revascularization compared to OMT. This benefit was larger with increasing follow-up duration. Personalized treatment based on patient characteristics and lesion complexity may optimize clinical outcomes in patients with CCS.<br /> (Copyright © 2023 Hellenic Society of Cardiology. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
2241-5955
Volume :
78
Database :
MEDLINE
Journal :
Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese
Publication Type :
Academic Journal
Accession number :
37949356
Full Text :
https://doi.org/10.1016/j.hjc.2023.10.003