Background: More than half of NSTEACS patients are presented with multivessel CAD. Culprit vessel only or complete revascularization (CR) guided either by angiography or fractional flow reserve (FFR) is available percutaneous coronary intervention (PCI) options. This study aims to compare different PCI strategies in NSTEACS patients with multivessel CAD.
Methods: Observational and RCTs studies are selected and compared for short- and long-term outcomes of all-cause mortality, MACE, and repeat revascularization. Odds ratio (OR) and SUCRA ranking of 4 interventions; (A) culprit vessel only revascularization, (B) single stage CR guided by angiography, (C) single stage CR guided by FFR, and (D) multistage CR guided by angiography are reported as pairwise and pooled network frequentist analysis conducted using RevMan and R software.
Results: Thirty- six studies with 213,254 patients were included. Pairwise analysis of A vs B shows no significant difference in short term outcomes. Pooled network analysis demonstrates that B, C, and D resulted in a significantly lower odds of long-term all-cause mortality compared to A (OR 0.42-0.77, 95 % CrI: 0.19-0.91). SUCRA ranking shows that C is more favorable compared to other interventions to reduce long term all-cause mortality and MACE (SUCRA 0.932 and 0.953). Sensitivity analysis with only RCTs and propensity matched scoring observational studies retains the significance and ranking of the interventions.
Conclusion: CR is just as safe as culprit vessel revascularization and single stage CR guided by FFR is the most preferable strategy to reduce risk of all- cause mortality and MACE.
Prospero Id: CRD42023491792.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.carrev.2024.10.009 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
A STEMI Complicated by Cardiogenic Shock Due to Simultaneous Acute Thrombosis of Two Coronary Vessels in the 'Deadly Double Infarct Syndrome': A Case Report and Discussion of Literature.
J Clin Med
December 2024
Department of Biomedical and Clinical Sciences, University of Milan, 20122 Milan, Italy.
: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of mortality worldwide, primarily caused by acute thrombosis over atherosclerotic plaques. Simultaneous acute thrombosis in two coronary arteries is an exceptionally rare event. This report highlights a unique case of STEMI associated with cardiogenic shock due to dual coronary artery thrombosis and provides insights from a literature review on this rare condition.
View Article and Find Full Text PDFLateral costal artery as a culprit for the steal phenomenon after coronary artery bypass grafting: a case report and review of the literature.
J Cardiothorac Surg
January 2025
Department of Heart Surgery, East Slovak Institute for Cardiovascular Diseases, Ondavská 8, Košice, 040 12, Slovakia.
Background: The left internal thoracic artery (LITA) has been widely accepted as the standard for revascularizing the left anterior descending artery during coronary artery bypass grafting (CABG) surgery. However, in 10-20% of cases, the LITA may lead to unsecured side branches to the chest wall, particularly the lateral costal artery (LCA), potentially resulting in postoperative chest angina.
Case Presentation: We report the case of a 58-year-old patient who experienced persistent angina eight months after having undergone coronary artery bypass grafting (CABG) due to the steal phenomenon caused by a thick lateral costal artery (LCA).
A 36-year-old woman with ulcerative colitis presented with progressive chest pain and neurovegetative symptoms. The electrocardiogram showed ST segment elevation in the inferior wall. The patient had a previous history of fatigue and night sweats.
View Article and Find Full Text PDFIntraoperative rescue of a dislodged renal stent during fenestrated endovascular aortic repair for treatment of type 1A endoleak.
J Vasc Surg Cases Innov Tech
February 2025
Division of Vascular and Endovascular Surgery, Cardio-Thoracic-Vascular Department, Integrated University Healthcare Giuliano-Isontina, University Hospital of Cattinara, Trieste, Italy.
In the past 15 years, fenestrated-branched endovascular aortic repair (F-BEVAR) has progressively become the first-line option for management of most complex abdominal aortic aneurysms (AAAs); with increasing experience, as well as persistent technological refinements, F-BEVAR indications have been expanded to include rescue of failures after prior EVAR. Despite the feasibility and effectiveness, F-BEVAR procedures in the presence of prior infrarenal endografts may come with higher technical complexity that should be properly anticipated, and several anatomical challenges can be expected. Among these, presence of suprarenal bare stents from prior EVAR device are certainly a frequent scenario and may sometimes make target vessel cannulation more difficult because of encroachment on the target vessel origins.
View Article and Find Full Text PDFClinical Characteristics and Outcomes of Elderly Patients Undergoing Primary Percutaneous Coronary Intervention: An Observational Cohort Study.
Glob Heart
January 2025
Adult Cardiology Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt.
Article Synopsis
- The study focused on elderly patients (70+) undergoing primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) at a tertiary center in Upper Egypt, highlighting a growing concern for cardiovascular disease in aging populations.
- The research included data from 3,627 patients, finding that 15.9% were elderly, with significantly higher in-hospital mortality rates, particularly among octogenarians (23.3%) compared to younger patients (4%).
- Elderly patients showed distinct clinical characteristics, such as higher rates of hypertension and chronic kidney disease, and were more likely to have severe complications post-procedure, emphasizing the need for tailored strategies in managing this demographic in cardiovascular care.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!