Outcomes After Complete Versus Incomplete Revascularization of Patients With Multivessel Coronary Artery Disease A Meta-Analysis of 89,883 Patients Enrolled in Randomized Clinical Trials and Observational Studies

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:62

Editorial Material

Garcia, Santiago^1,2  Sandoval, Yader³  Roukoz, Henri²  Adabag, Selcuk^1,2  Canoniero, Mariana⁴  Yannopoulos, Demetris²  Brilakis, Emmanouil S.^5,6 

[1] Minneapolis Vet Affairs Healthcare Syst, Dept Med, Div Cardiol, Minneapolis, MN USA

[2] Univ Minnesota, Sch Med, Dept Med, Minneapolis, MN 55455 USA

[3] Hennepin Cty Med Ctr, Dept Med, Minneapolis, MN 55415 USA

[4] Pk Nicollet Clin Heart & Vasc Ctr, Div Cardiol, Dept Med, St Louis Pk, MN USA

[5] VA North Texas Healthcare Syst, Div Cardiol, Dept Med, Dallas, TX USA

[6] Univ Texas Southwestern Med Sch, Dallas, TX USA

关键词: complete revascularization;    coronary artery bypass surgery;    coronary artery disease;    meta-analysis;    percutaneous coronary intervention;   

DOI  :  10.1016/j.jacc.2013.05.033

来源: Elsevier

【 摘 要 】

Objectives This study sought to perform a systematic review and meta-analysis of studies comparing complete revascularization (CR) versus incomplete revascularization (IR) in patients with multivessel coronary artery disease. Background There are conflicting data regarding the benefits of CR in patients with multivessel coronary artery disease. Methods We identified observational studies and subgroup analysis of randomized clinical trials (RCT) published in PubMed from 1970 through September 2012 using the following keywords: percutaneous coronary intervention (PCI); coronary artery bypass graft (CABG); complete revascularization; and incomplete revascularization. Main outcome measures were total mortality, myocardial infarction, and repeat revascularization procedures. Results We identified 35 studies including 89,883 patients, of whom 45,417 (50.5%) received CR and 44,466 (49.5%) received IR. IR was more common after PCI than after CABG (56% vs. 25%; p < 0.001). Relative to IR, CR was associated with lower long-term mortality (risk ratio [RR]: 0.71, 95% confidence interval [CI]: 0.65 to 0.77; p < 0.001), myocardial infarction (RR: 0.78, 95% CI: 0.68 to 0.90; p = 0.001), and repeat coronary revascularization (RR: 0.74, 95% CI: 0.65 to 0.83; p < 0.001). The mortality benefit associated with CR was consistent across studies irrespective of revascularization modality (CABG: RR: 0.70, 95% CI: 0.61 to 0.80; p < 0.001; and PCI: RR: 0.72, 95% CI: 0.64 to 0.81; p < 0.001) and definition of CR (anatomic definition: RR: 0.73, 95% CI: 0.67 to 0.79; p < 0.001; and nonanatomic definition: RR: 0.57, 95% CI: 0.36 to 0.89; p = 0.014). Conclusions CR is achieved more commonly with CABG than with PCI. Among patients with multivessel coronary artery disease, CR may be the optimal revascularization strategy. (c) 2013 by the American College of Cardiology Foundation

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