Immediate vs. multistage revascularization of non-infarct coronary artery(-ies) in patients with hemodynamically stable multivessel disease acute myocardial infarction: a systematic review and meta-analysis.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2024-08-01 Epub Date: 2024-03-08 DOI:10.1097/MCA.0000000000001353

Prakash Raj Oli, Dhan Bahadur Shrestha, Sagun Dawadi, Jurgen Shtembari, Laxmi Regmi, Kailash Pant, Bishesh Shrestha, Jishanth Mattumpuram, Daniel H Katz

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引用次数: 0

Abstract

Background: Untreated multivessel disease (MVD) in acute myocardial infarction (AMI) has been linked to a higher risk of recurrent ischemia and death within one year . Current guidelines recommend percutaneous coronary intervention (PCI) for significant non-infarct artery (-ies) (non-IRA) stenosis in hemodynamically stable AMI patients with MVD, either during or after successful primary PCI, within 45-days. However, deciding the timing of revascularization for non-IRA in cases of MVD is uncertain.

Methods: This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023472652). Databases were searched for relevant articles published before 10 November 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4.

Results: Out of 640 studies evaluated, there were 13 RCTs with 5144 patients with AMI with MVD. The immediate non-IRA PCI is associated with a significantly lower occurrence of unplanned ischemia-driven PCI (OR 0.60; confidence interval [CI] 0.44-0.83) and target-vessel revascularization (OR 0.72; CI 0.53-0.97) . Although there is a favorable trend for major adverse cardiovascular and cerebrovascular events (MACCE), nonfatal AMI, cerebrovascular events, and major bleeding in the immediate non-culprit artery (-ies) PCI, those were statistically non-significant. Similarly, all-cause mortality, cardiovascular mortality, stent thrombosis, and acute renal insufficiency did not show significant differences between two groups.

Conclusion: Among hemodynamically stable patients with multivessel AMI, the immediate PCI strategy was superior to the multistage PCI strategy for the unplanned ischemia-driven PCI and target-vessel revascularization while odds are favorable in terms of MACCE, nonfatal AMI, cerebrovascular events, and major bleeding at longest follow-up.

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对血流动力学稳定的多血管疾病急性心肌梗死患者立即进行非梗死冠状动脉血运重建与多级血运重建的比较：系统综述和荟萃分析。

背景：急性心肌梗死（AMI）中未经治疗的多支血管疾病（MVD）与较高的一年内复发缺血和死亡风险有关。目前的指南建议，对于血流动力学稳定的急性心肌梗死（AMI）患者，如果存在明显的非梗死动脉（-ies）（非IRA）狭窄，可在初级PCI成功期间或之后的45天内进行经皮冠状动脉介入治疗（PCI）。然而，在 MVD 病例中决定非 IRA 血管再通的时机尚不确定：本荟萃分析是在PROSPERO（CRD42023472652）注册后根据PRISMA指南进行的。在数据库中搜索了 2023 年 11 月 10 日之前发表的相关文章。使用 RevMan v5.4 对纳入研究的相关数据进行提取和分析：在评估的 640 项研究中，有 13 项 RCT，涉及 5144 名合并 MVD 的 AMI 患者。立即进行非 IRA PCI 与计划外缺血驱动 PCI（OR 0.60；置信区间 [CI]0.44-0.83）和靶血管再通术（OR 0.72；CI 0.53-0.97）的发生率显著降低相关。虽然立即进行非冠状动脉（-ies）PCI 对主要不良心脑血管事件（MACCE）、非致命性急性心肌梗死、脑血管事件和大出血有有利趋势，但在统计学上并不显著。同样，全因死亡率、心血管死亡率、支架血栓形成和急性肾功能不全在两组间也无显著差异：结论：在血流动力学稳定的多支血管急性心肌梗死患者中，对于非计划性缺血驱动的 PCI 和靶血管再通术，立即 PCI 策略优于多阶段 PCI 策略，而在最长随访时间内，MACCE、非致死性急性心肌梗死、脑血管事件和大出血的几率也较高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.