Death and Myocardial Infarction Following Initial Revascularization Versus Optimal Medical Therapy in Chronic Coronary Syndromes With Myocardial Ischemia: A Systematic Review and Meta-Analysis of Contemporary Randomized Controlled Trials
Background In chronic coronary syndromes, myocardial ischemia is associated with a greater risk of death and nonfatal myocardial infarction (MI). We sought to compare the effect of initial revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) plus...
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| Veröffentlicht in: | Journal of the American Heart Association 2021-01, Vol.10 (2), p.e019114-e019114, Article 019114 |
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| creator | Soares, Andrea Boden, William E. Hueb, Whady Brooks, Maria M. Vlachos, Helen E. A. O'Fee, Kevin Hardi, Angela Brown, David L. |
| description | Background
In chronic coronary syndromes, myocardial ischemia is associated with a greater risk of death and nonfatal myocardial infarction (MI). We sought to compare the effect of initial revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) plus optimal medical therapy (OMT) with OMT alone in patients with chronic coronary syndrome and myocardial ischemia on long-term death and nonfatal MI.
Methods and Results
Ovid Medline, Embase, Scopus, and Cochrane Library databases were searched for randomized controlled trials of PCI or CABG plus OMT versus OMT alone for patients with chronic coronary syndromes. Studies were screened and data were extracted independently by 2 authors. Random-effects models were used to generate pooled treatment effects. The search yielded 7 randomized controlled trials that randomized 10 797 patients. Median follow-up was 5 years. Death occurred in 640 of the 5413 patients (11.8%) randomized to revascularization and in 647 of the 5384 patients (12%) randomized to OMT (odds ratio [OR], 0.97; 95% CI, 0.86-1.09; P=0.60). Nonfatal MI was reported in 554 of 5413 patients (10.2%) in the revascularization arms compared with 627 of 5384 patients (11.6%) in the OMT arms (OR, 0.75; 95% CI, 0.57-0.99; P=0.04). In subgroup analysis, nonfatal MI was significantly reduced by CABG (OR, 0.35; 95% CI, 0.21-0.59; P |
| doi_str_mv | 10.1161/JAHA.120.019114 |
| format | Article |
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In chronic coronary syndromes, myocardial ischemia is associated with a greater risk of death and nonfatal myocardial infarction (MI). We sought to compare the effect of initial revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) plus optimal medical therapy (OMT) with OMT alone in patients with chronic coronary syndrome and myocardial ischemia on long-term death and nonfatal MI.
Methods and Results
Ovid Medline, Embase, Scopus, and Cochrane Library databases were searched for randomized controlled trials of PCI or CABG plus OMT versus OMT alone for patients with chronic coronary syndromes. Studies were screened and data were extracted independently by 2 authors. Random-effects models were used to generate pooled treatment effects. The search yielded 7 randomized controlled trials that randomized 10 797 patients. Median follow-up was 5 years. Death occurred in 640 of the 5413 patients (11.8%) randomized to revascularization and in 647 of the 5384 patients (12%) randomized to OMT (odds ratio [OR], 0.97; 95% CI, 0.86-1.09; P=0.60). Nonfatal MI was reported in 554 of 5413 patients (10.2%) in the revascularization arms compared with 627 of 5384 patients (11.6%) in the OMT arms (OR, 0.75; 95% CI, 0.57-0.99; P=0.04). In subgroup analysis, nonfatal MI was significantly reduced by CABG (OR, 0.35; 95% CI, 0.21-0.59; P<0.001) but was not reduced by PCI (OR, 0.92; 95% CI, 0.75-1.13; P=0.43) (P-interaction <0.001).
Conclusions
In patients with chronic coronary syndromes and myocardial ischemia, initial revascularization with PCI or CABG plus OMT did not reduce long-term mortality compared with OMT alone. CABG plus OMT reduced nonfatal MI compared with OMT alone, whereas PCI did not.</description><identifier>ISSN: 2047-9980</identifier><identifier>EISSN: 2047-9980</identifier><identifier>DOI: 10.1161/JAHA.120.019114</identifier><identifier>PMID: 33442990</identifier><language>eng</language><publisher>HOBOKEN: Wiley</publisher><subject>Cardiac & Cardiovascular Systems ; Cardiovascular System & Cardiology ; coronary artery bypass grafting ; coronary artery disease ; Life Sciences & Biomedicine ; myocardial ischemia ; percutaneous coronary intervention ; Science & Technology ; Systematic Review and Meta‐analysis</subject><ispartof>Journal of the American Heart Association, 2021-01, Vol.10 (2), p.e019114-e019114, Article 019114</ispartof><rights>2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>16</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000610049900019</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c459t-5cc6b33d8e917ea0cd9baa0dd69c0dcbf25792d8539aee287126c0ef4979e0f13</citedby><cites>FETCH-LOGICAL-c459t-5cc6b33d8e917ea0cd9baa0dd69c0dcbf25792d8539aee287126c0ef4979e0f13</cites><orcidid>0000-0002-0930-9747 ; 0000-0002-3166-6054 ; 0000-0001-5693-8979</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955292/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955292/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,729,782,786,866,887,2106,2118,27933,27934,39267,53800,53802</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33442990$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Soares, Andrea</creatorcontrib><creatorcontrib>Boden, William E.</creatorcontrib><creatorcontrib>Hueb, Whady</creatorcontrib><creatorcontrib>Brooks, Maria M.</creatorcontrib><creatorcontrib>Vlachos, Helen E. A.</creatorcontrib><creatorcontrib>O'Fee, Kevin</creatorcontrib><creatorcontrib>Hardi, Angela</creatorcontrib><creatorcontrib>Brown, David L.</creatorcontrib><title>Death and Myocardial Infarction Following Initial Revascularization Versus Optimal Medical Therapy in Chronic Coronary Syndromes With Myocardial Ischemia: A Systematic Review and Meta-Analysis of Contemporary Randomized Controlled Trials</title><title>Journal of the American Heart Association</title><addtitle>J AM HEART ASSOC</addtitle><addtitle>J Am Heart Assoc</addtitle><description>Background
In chronic coronary syndromes, myocardial ischemia is associated with a greater risk of death and nonfatal myocardial infarction (MI). We sought to compare the effect of initial revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) plus optimal medical therapy (OMT) with OMT alone in patients with chronic coronary syndrome and myocardial ischemia on long-term death and nonfatal MI.
Methods and Results
Ovid Medline, Embase, Scopus, and Cochrane Library databases were searched for randomized controlled trials of PCI or CABG plus OMT versus OMT alone for patients with chronic coronary syndromes. Studies were screened and data were extracted independently by 2 authors. Random-effects models were used to generate pooled treatment effects. The search yielded 7 randomized controlled trials that randomized 10 797 patients. Median follow-up was 5 years. Death occurred in 640 of the 5413 patients (11.8%) randomized to revascularization and in 647 of the 5384 patients (12%) randomized to OMT (odds ratio [OR], 0.97; 95% CI, 0.86-1.09; P=0.60). Nonfatal MI was reported in 554 of 5413 patients (10.2%) in the revascularization arms compared with 627 of 5384 patients (11.6%) in the OMT arms (OR, 0.75; 95% CI, 0.57-0.99; P=0.04). In subgroup analysis, nonfatal MI was significantly reduced by CABG (OR, 0.35; 95% CI, 0.21-0.59; P<0.001) but was not reduced by PCI (OR, 0.92; 95% CI, 0.75-1.13; P=0.43) (P-interaction <0.001).
Conclusions
In patients with chronic coronary syndromes and myocardial ischemia, initial revascularization with PCI or CABG plus OMT did not reduce long-term mortality compared with OMT alone. CABG plus OMT reduced nonfatal MI compared with OMT alone, whereas PCI did not.</description><subject>Cardiac & Cardiovascular Systems</subject><subject>Cardiovascular System & Cardiology</subject><subject>coronary artery bypass grafting</subject><subject>coronary artery disease</subject><subject>Life Sciences & Biomedicine</subject><subject>myocardial ischemia</subject><subject>percutaneous coronary intervention</subject><subject>Science & Technology</subject><subject>Systematic Review and Meta‐analysis</subject><issn>2047-9980</issn><issn>2047-9980</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>DOA</sourceid><recordid>eNqNkk1vEzEQhlcIRKvQMze0RySU1PZ-xRyQokBpUKtKJcDRmrVnG1e7drA3jdL_zH9gkpQovbGXscbPPmNbb5K85WzEecnPv00uJyMu2IhxyXn-IjkVLK-GUo7Zy6P1SXIW4z2jrxRVVsjXyUmW5bmQkp0mfz4j9IsUnEmvN15DMBbadOYaCLq33qUXvm392ro7atp-u3mLDxD1qoVgH2HH_MQQVzG9Wfa2I-AajdVU5wsMsNyk1qXTRfDO6nTqqULYpN83zgTfYUx_WZp_PDvqBXYWPqYTomKPHQ3R26kW1_uDYg_DiYN2E21MfUNWR9jSh635lhDf2Uc0u36g89NyHsgd3ySvGip49lQHyY-LL_Pp5fDq5utsOrka6ryQ_bDQuqyzzIxR8gqBaSNrAGZMKTUzum5EUUlhxkUmAVGMKy5KzbDJZSWRNTwbJLO913i4V8tAzxI2yoNVu4YPdwoC3apFxZEhz2omhBY5ZwBQ8kxIVmvylkVDrk9713JVd2g00p2gfSZ9vuPsQt35B1XJohBSkOD9kyD43yuMveps1Ni24NCvohJ5NWY5Lygcg-R8j-rgYwzYHMZwpraZU9vMKcqc2meO_nh3fLoD_y9hBHzYA2usfRO1RafxgG1DyRnLiWRkJHr8__TU9rv8Tf3K9dlf3CH5pw</recordid><startdate>20210119</startdate><enddate>20210119</enddate><creator>Soares, Andrea</creator><creator>Boden, William E.</creator><creator>Hueb, Whady</creator><creator>Brooks, Maria M.</creator><creator>Vlachos, Helen E. A.</creator><creator>O'Fee, Kevin</creator><creator>Hardi, Angela</creator><creator>Brown, David L.</creator><general>Wiley</general><general>John Wiley and Sons Inc</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-0930-9747</orcidid><orcidid>https://orcid.org/0000-0002-3166-6054</orcidid><orcidid>https://orcid.org/0000-0001-5693-8979</orcidid></search><sort><creationdate>20210119</creationdate><title>Death and Myocardial Infarction Following Initial Revascularization Versus Optimal Medical Therapy in Chronic Coronary Syndromes With Myocardial Ischemia: A Systematic Review and Meta-Analysis of Contemporary Randomized Controlled Trials</title><author>Soares, Andrea ; Boden, William E. ; Hueb, Whady ; Brooks, Maria M. ; Vlachos, Helen E. A. ; O'Fee, Kevin ; Hardi, Angela ; Brown, David L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-5cc6b33d8e917ea0cd9baa0dd69c0dcbf25792d8539aee287126c0ef4979e0f13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cardiac & Cardiovascular Systems</topic><topic>Cardiovascular System & Cardiology</topic><topic>coronary artery bypass grafting</topic><topic>coronary artery disease</topic><topic>Life Sciences & Biomedicine</topic><topic>myocardial ischemia</topic><topic>percutaneous coronary intervention</topic><topic>Science & Technology</topic><topic>Systematic Review and Meta‐analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soares, Andrea</creatorcontrib><creatorcontrib>Boden, William E.</creatorcontrib><creatorcontrib>Hueb, Whady</creatorcontrib><creatorcontrib>Brooks, Maria M.</creatorcontrib><creatorcontrib>Vlachos, Helen E. A.</creatorcontrib><creatorcontrib>O'Fee, Kevin</creatorcontrib><creatorcontrib>Hardi, Angela</creatorcontrib><creatorcontrib>Brown, David L.</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Journal of the American Heart Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soares, Andrea</au><au>Boden, William E.</au><au>Hueb, Whady</au><au>Brooks, Maria M.</au><au>Vlachos, Helen E. A.</au><au>O'Fee, Kevin</au><au>Hardi, Angela</au><au>Brown, David L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Death and Myocardial Infarction Following Initial Revascularization Versus Optimal Medical Therapy in Chronic Coronary Syndromes With Myocardial Ischemia: A Systematic Review and Meta-Analysis of Contemporary Randomized Controlled Trials</atitle><jtitle>Journal of the American Heart Association</jtitle><stitle>J AM HEART ASSOC</stitle><addtitle>J Am Heart Assoc</addtitle><date>2021-01-19</date><risdate>2021</risdate><volume>10</volume><issue>2</issue><spage>e019114</spage><epage>e019114</epage><pages>e019114-e019114</pages><artnum>019114</artnum><issn>2047-9980</issn><eissn>2047-9980</eissn><abstract>Background
In chronic coronary syndromes, myocardial ischemia is associated with a greater risk of death and nonfatal myocardial infarction (MI). We sought to compare the effect of initial revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) plus optimal medical therapy (OMT) with OMT alone in patients with chronic coronary syndrome and myocardial ischemia on long-term death and nonfatal MI.
Methods and Results
Ovid Medline, Embase, Scopus, and Cochrane Library databases were searched for randomized controlled trials of PCI or CABG plus OMT versus OMT alone for patients with chronic coronary syndromes. Studies were screened and data were extracted independently by 2 authors. Random-effects models were used to generate pooled treatment effects. The search yielded 7 randomized controlled trials that randomized 10 797 patients. Median follow-up was 5 years. Death occurred in 640 of the 5413 patients (11.8%) randomized to revascularization and in 647 of the 5384 patients (12%) randomized to OMT (odds ratio [OR], 0.97; 95% CI, 0.86-1.09; P=0.60). Nonfatal MI was reported in 554 of 5413 patients (10.2%) in the revascularization arms compared with 627 of 5384 patients (11.6%) in the OMT arms (OR, 0.75; 95% CI, 0.57-0.99; P=0.04). In subgroup analysis, nonfatal MI was significantly reduced by CABG (OR, 0.35; 95% CI, 0.21-0.59; P<0.001) but was not reduced by PCI (OR, 0.92; 95% CI, 0.75-1.13; P=0.43) (P-interaction <0.001).
Conclusions
In patients with chronic coronary syndromes and myocardial ischemia, initial revascularization with PCI or CABG plus OMT did not reduce long-term mortality compared with OMT alone. CABG plus OMT reduced nonfatal MI compared with OMT alone, whereas PCI did not.</abstract><cop>HOBOKEN</cop><pub>Wiley</pub><pmid>33442990</pmid><doi>10.1161/JAHA.120.019114</doi><tpages>28</tpages><orcidid>https://orcid.org/0000-0002-0930-9747</orcidid><orcidid>https://orcid.org/0000-0002-3166-6054</orcidid><orcidid>https://orcid.org/0000-0001-5693-8979</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley-Blackwell Open Access Collection; Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; PubMed Central; Directory of Open Access Journals; EZB Electronic Journals Library |
| subjects | Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology coronary artery bypass grafting coronary artery disease Life Sciences & Biomedicine myocardial ischemia percutaneous coronary intervention Science & Technology Systematic Review and Meta‐analysis |
| title | Death and Myocardial Infarction Following Initial Revascularization Versus Optimal Medical Therapy in Chronic Coronary Syndromes With Myocardial Ischemia: A Systematic Review and Meta-Analysis of Contemporary Randomized Controlled Trials |
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