Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis
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- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University , Bydgoszcz, Poland
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- Alexandra J Lansky
- Yale University School of Medicine , New Haven, CT, USA
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- Dean J Kereiakes
- Christ Hospital and Lindner Research Center , Cincinnati, OH, USA
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- Jacek Kubica
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University , Bydgoszcz, Poland
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- Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore , Baltimore, MD, USA
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- Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College , London, UK
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- Marco Valgimigli
- Department of Cardiology, Inselspital Universitätsspital , Bern, Switzerland
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- Nick Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton , UK
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- David E Kandzari
- Department of Interventional Cardiology, Piedmont Heart Institute , Atlanta, GA, USA
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- Marc P Bonaca
- CPC Clinical Research, University of Colorado School of Medicine , USA
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- Marc Brouwer
- Department of Cardiology, Radboud University Medical Centre , Nijmegen, the Netherlands
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- Julia Umińska
- Department of Geriatrics, Nicolaus Copernicus University , Bydgoszcz, Poland
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- Milosz J Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk , Gdansk, Poland
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- Paolo Raggi
- Faculty of Medicine, University of Alberta , Edmonton, Canada
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- Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center , Washington, DC, USA
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- Martin B Leon
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center , New York, NY, USA
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- William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group , Galway, Ireland
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- Felicita Andreotti
- Direzione Scientifica, Fondazione Policlinico Universitario Gemelli IRCCS , Rome, Italy
Abstract
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims</jats:title> <jats:p>The value of elective coronary revascularisation plus medical therapy over medical therapy alone in managing stable patients with coronary artery disease is debated. We reviewed all trials comparing the two strategies in this population.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results</jats:title> <jats:p>From inception through November 2020, MEDLINE, EMBASE, Google Scholar, and other databases were searched for randomised trials comparing revascularisation against medical therapy alone in clinically stable coronary artery disease patients. Treatment effects were measured by rate ratios (RRs) with 95% confidence intervals, using random-effects models. Cardiac mortality was the pre-specified primary endpoint. Spontaneous myocardial infarction (MI) and its association with cardiac mortality were secondary endpoints. Further endpoints included all-cause mortality, any MI, and stroke. Longest follow-up data were abstracted. The study is registered with PROSPERO (CRD42021225598). Twenty-five trials involving 19 806 patients (10 023 randomised to revascularisation plus medical therapy and 9783 to medical therapy alone) were included. Compared with medical therapy alone, revascularisation yielded a lower risk of cardiac death [RR 0.79 (0.67–0.93), P < 0.01] and spontaneous MI [RR 0.74 (0.64–0.86), P < 0.01]. By meta-regression, the cardiac death risk reduction after revascularisation, compared with medical therapy alone, was linearly associated with follow-up duration [RR per 4-year follow-up: 0.81 (0.69–0.96), P = 0.008], spontaneous MI absolute difference (P = 0.01) and percentage of multivessel disease at baseline (P = 0.004). Trial sequential and sensitivity analyses confirmed the reliability of the cardiac mortality findings. All-cause mortality [0.94 (0.87–1.01), P = 0.11], any MI (P = 0.14), and stroke risk (P = 0.30) did not differ significantly between strategies.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>In stable coronary artery disease patients, randomisation to elective coronary revascularisation plus medical therapy led to reduced cardiac mortality compared with medical therapy alone. The cardiac survival benefit after revascularisation improved with longer follow-up times and was associated with fewer spontaneous MIs.</jats:p> </jats:sec>
Journal
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- European Heart Journal
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European Heart Journal 42 (45), 4638-4651, 2021-05-18
Oxford University Press (OUP)
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Details 詳細情報について
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- CRID
- 1360857672450150784
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- ISSN
- 15229645
- 0195668X
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- Data Source
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- Crossref