Chidubem Ezenna, Mrinal Murali Krishna, Meghna Joseph, Vinicius Pereira, Prasana Ramesh, Mahmoud Ismayl, Michael G Nanna, Andrew M Goldsweig
{"title":"心肌梗死患者的分流血流储备引导下的完全血运重建术与仅罪魁祸首的经皮冠状动脉介入治疗：随机对照试验的荟萃分析","authors":"Chidubem Ezenna, Mrinal Murali Krishna, Meghna Joseph, Vinicius Pereira, Prasana Ramesh, Mahmoud Ismayl, Michael G Nanna, Andrew M Goldsweig","doi":"10.1016/j.carrev.2024.12.004","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The optimal revascularization strategy for patients with myocardial infarction (MI) and multivessel coronary artery disease (CAD) remains an area of research and debate. Fractional flow reserve (FFR)-guided complete revascularization (CR) by percutaneous coronary intervention (PCI) has emerged as an alternative to traditional culprit-only PCI.</p><p><strong>Objective: </strong>To investigate the outcomes of FFR-guided CR versus culprit-only PCI in patients with MI and multivessel CAD.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus and Cochrane Central databases for randomized controlled trials (RCTs) comparing FFR-guided CR versus culprit-only PCI in MI patients with multivessel CAD. Outcomes included a composite of all-cause death, MI, stroke and repeat revascularization, these individual outcomes, cardiac death, stent thrombosis (definite or probable), and contrast-induced acute kidney injury (CIAKI). Random effects models were used to generate risk ratios (RRs) with 95 % confidence intervals (CIs).</p><p><strong>Result: </strong>The search identified 5 RCTs including 4618 patients with a median follow-up duration of 3 years. Compared with culprit-only PCI, FFR-guided CR was associated with less composite adverse events (RR 0.73; 95%CI 0.57-0.92; p = 0.009), cardiac death (RR 0.73; 95%CI 0.55-0.97; p = 0.03), and repeat revascularization (RR 0.61; 95%CI 0.44-0.84; p = 0.003). Both strategies were similar in terms of all-cause death, MI, stroke, stent thrombosis, and CIAKI.</p><p><strong>Conclusion: </strong>FFR-guided complete revascularization appears to be superior to culprit-only PCI in reducing composite adverse events, cardiac death, and the need for repeat revascularization in patients with MI and multivessel CAD without a significant impact on recurrent myocardial infarction rates.</p><p><strong>Social media abstract: </strong>4618-patient meta-analysis: in MI w/ multivessel #CAD, #FFR-guided complete revascularization yields less composite adverse events, cardiac death & repeat revascularization than culprit-only #PCI.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Fractional flow reserve-guided complete revascularization versus culprit-only percutaneous coronary intervention in patients with myocardial infarction: A meta-analysis of randomized controlled trials.\",\"authors\":\"Chidubem Ezenna, Mrinal Murali Krishna, Meghna Joseph, Vinicius Pereira, Prasana Ramesh, Mahmoud Ismayl, Michael G Nanna, Andrew M Goldsweig\",\"doi\":\"10.1016/j.carrev.2024.12.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The optimal revascularization strategy for patients with myocardial infarction (MI) and multivessel coronary artery disease (CAD) remains an area of research and debate. Fractional flow reserve (FFR)-guided complete revascularization (CR) by percutaneous coronary intervention (PCI) has emerged as an alternative to traditional culprit-only PCI.</p><p><strong>Objective: </strong>To investigate the outcomes of FFR-guided CR versus culprit-only PCI in patients with MI and multivessel CAD.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus and Cochrane Central databases for randomized controlled trials (RCTs) comparing FFR-guided CR versus culprit-only PCI in MI patients with multivessel CAD. Outcomes included a composite of all-cause death, MI, stroke and repeat revascularization, these individual outcomes, cardiac death, stent thrombosis (definite or probable), and contrast-induced acute kidney injury (CIAKI). Random effects models were used to generate risk ratios (RRs) with 95 % confidence intervals (CIs).</p><p><strong>Result: </strong>The search identified 5 RCTs including 4618 patients with a median follow-up duration of 3 years. Compared with culprit-only PCI, FFR-guided CR was associated with less composite adverse events (RR 0.73; 95%CI 0.57-0.92; p = 0.009), cardiac death (RR 0.73; 95%CI 0.55-0.97; p = 0.03), and repeat revascularization (RR 0.61; 95%CI 0.44-0.84; p = 0.003). Both strategies were similar in terms of all-cause death, MI, stroke, stent thrombosis, and CIAKI.</p><p><strong>Conclusion: </strong>FFR-guided complete revascularization appears to be superior to culprit-only PCI in reducing composite adverse events, cardiac death, and the need for repeat revascularization in patients with MI and multivessel CAD without a significant impact on recurrent myocardial infarction rates.</p><p><strong>Social media abstract: </strong>4618-patient meta-analysis: in MI w/ multivessel #CAD, #FFR-guided complete revascularization yields less composite adverse events, cardiac death & repeat revascularization than culprit-only #PCI.</p>\",\"PeriodicalId\":47657,\"journal\":{\"name\":\"Cardiovascular Revascularization Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-12-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular Revascularization Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.carrev.2024.12.004\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Revascularization Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.carrev.2024.12.004","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Fractional flow reserve-guided complete revascularization versus culprit-only percutaneous coronary intervention in patients with myocardial infarction: A meta-analysis of randomized controlled trials.
Introduction: The optimal revascularization strategy for patients with myocardial infarction (MI) and multivessel coronary artery disease (CAD) remains an area of research and debate. Fractional flow reserve (FFR)-guided complete revascularization (CR) by percutaneous coronary intervention (PCI) has emerged as an alternative to traditional culprit-only PCI.
Objective: To investigate the outcomes of FFR-guided CR versus culprit-only PCI in patients with MI and multivessel CAD.
Methods: We systematically searched PubMed, Scopus and Cochrane Central databases for randomized controlled trials (RCTs) comparing FFR-guided CR versus culprit-only PCI in MI patients with multivessel CAD. Outcomes included a composite of all-cause death, MI, stroke and repeat revascularization, these individual outcomes, cardiac death, stent thrombosis (definite or probable), and contrast-induced acute kidney injury (CIAKI). Random effects models were used to generate risk ratios (RRs) with 95 % confidence intervals (CIs).
Result: The search identified 5 RCTs including 4618 patients with a median follow-up duration of 3 years. Compared with culprit-only PCI, FFR-guided CR was associated with less composite adverse events (RR 0.73; 95%CI 0.57-0.92; p = 0.009), cardiac death (RR 0.73; 95%CI 0.55-0.97; p = 0.03), and repeat revascularization (RR 0.61; 95%CI 0.44-0.84; p = 0.003). Both strategies were similar in terms of all-cause death, MI, stroke, stent thrombosis, and CIAKI.
Conclusion: FFR-guided complete revascularization appears to be superior to culprit-only PCI in reducing composite adverse events, cardiac death, and the need for repeat revascularization in patients with MI and multivessel CAD without a significant impact on recurrent myocardial infarction rates.
Social media abstract: 4618-patient meta-analysis: in MI w/ multivessel #CAD, #FFR-guided complete revascularization yields less composite adverse events, cardiac death & repeat revascularization than culprit-only #PCI.
期刊介绍：
Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
