Difference in spontaneous myocardial infarction and mortality in percutaneous versus surgical revascularization trials: A systematic review and meta-analysis |
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| Affiliation: | 1. Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY;2. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom;3. Samuel J. Wood Library & C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY;4. Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;5. Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University of Jena, Jena, Germany;1. Division of Cardiac Surgery, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY;2. Division of Cardiac Surgery, Department of Surgery, Adventist HealthCare, Silver Spring, Md;1. Division of Cardiac Surgery, University of Virginia, Charlottesville, Va;2. Virginia Cardiac Services Quality Initiative, Falls Church, Va;3. Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich;4. Department of Cardiac Surgery, Queen Elizabeth University Hospital, Birmingham, United Kingdom;5. Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY;6. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md;7. Inova Heart and Vascular Institute, Falls Church, Va;8. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich;9. Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa;1. Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio;2. Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio;3. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio;1. Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY;2. Department of Cardiac Surgery, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom;3. Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom |
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| Abstract: | ObjectivesIt has been hypothesized that the survival benefit of coronary artery bypass (CABG) compared with percutaneous interventions (PCI) may be associated with the reduction in spontaneous myocardial infarction (SMI) achieved by surgery. This, however, has not been formally investigated. The present meta-analysis aims to evaluate the association between the difference in SMI and in survival in PCI versus CABG randomized controlled trials (RCTs).MethodsA systematic search was performed to identify all RCTs comparing PCI with CABG for the treatment of coronary artery disease and reporting SMI outcomes. Generic inverse variance method was used to pool outcomes as natural logarithms of the incident rate ratios across studies. Subgroup analysis and interaction test were used to compare the difference of the primary outcome among trials that did and did not report a significant reduction in SMI- in the patients treated by CABG. Primary outcome was all-cause mortality; secondary outcome was SMI.ResultsTwenty RCTs were included in the meta-analysis. A statistically significant difference in SMI in favor of CABG was found in 7 of the included trials (35%). Overall, PCI was associated with significantly greater all-cause mortality (incident rate ratio, 1.13; 95% confidence interval, 1.01-1.28). At subgroup analysis, a significant difference in survival in favor of CABG was seen only in trials that reported a significant reduction in SMI in the surgical arm (P for interaction 0.02).ConclusionsIn the published PCI versus CABG trials, the reduction in all-cause mortality in the surgical arm is associated with the protective effect of CABG against SMI. |
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| Keywords: | PCI CABG myocardial infarction CABG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0030" }," $$" :[{" #name" :" text" ," _" :" coronary artery bypass grafting CAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" coronary artery disease CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" confidence interval IRR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" incident rate ratio PCI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" percutaneous coronary intervention RCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" randomized controlled trial SMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" spontaneous myocardial infarction |
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