Comparison of invasive treatment strategies in patients with non-ST elevation acute coronary syndrome: A systematic review and meta-analysis.
CABG, coronary artery bypass grafting
CI, confidence interval
DES, drug-eluting stent
HR, hazard ratio
MVD, multivessel disease
NSTE-ACS, non–ST elevation acute coronary syndrome
PCI, percutaneous coronary intervention
RCT, randomized controlled trial
RMST, restricted mean survival time
all-cause mortality
coronary artery bypass grafting
meta-analysis
non–ST elevation acute coronary syndrome
percutaneous coronary intervention
Journal
JTCVS open
ISSN: 2666-2736
Titre abrégé: JTCVS Open
Pays: Netherlands
ID NLM: 101768541
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
04
01
2021
accepted:
20
08
2021
entrez:
25
8
2022
pubmed:
26
8
2022
medline:
26
8
2022
Statut:
epublish
Résumé
To compare the mortality associated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). We searched publications from PubMed, Embase, Web of Science, and the Cochrane Library from inception until December 23, 2020. All randomized clinical trials (RCTs) and observational studies comparing all-cause mortality after treatment with CABG versus PCI for patients with NSTE-ACS with minimum follow-up of 6 months were included. Restricted mean survival time (RMST) differences from RCTs and adjusted RMST differences from observational studies were computed by reconstructing time-to-event data from published Kaplan-Meier curves. Extracted hazard ratios (HRs) were also assessed as a secondary analysis. Our systematic review included an individual participant data analysis of 3 RCTs and 8 observational studies. A meta-regression showed a significant association between log-transformed HRs and duration of follow-up (-0.009 [95% confidence interval (CI), -0.002 to -0.016] log-HR per 1-year longer follow-up; There was a trend toward a benefit of CABG compared with PCI in the longer follow-up in patients with NSTE-ACS. A large, well-designed RCT with longer follow-up is needed to obtain definitive evidence on this topic.
Identifiants
pubmed: 36004105
doi: 10.1016/j.xjon.2021.08.028
pii: S2666-2736(21)00258-8
pmc: PMC9390253
doi:
Types de publication
Journal Article
Langues
eng
Pagination
323-335Informations de copyright
© 2021 The Author(s).
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