A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome
Abstract Non-ST-elevation acute coronary syndrome (NSTE-ACS) affects millions of patients. Although an invasive strategy can improve survival, the optimal treatment [i.e., percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] is not clear. We performed a meta-analysis o...
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Nature Portfolio
2022-03-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-022-09158-0 |
| _version_ | 1811332153376505856 |
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| author | Hristo Kirov Tulio Caldonazo Mohamed Rahouma N. Bryce Robinson Michelle Demetres Patrick W. Serruys Giuseppe Biondi-Zoccai Mario Gaudino Torsten Doenst |
| author_facet | Hristo Kirov Tulio Caldonazo Mohamed Rahouma N. Bryce Robinson Michelle Demetres Patrick W. Serruys Giuseppe Biondi-Zoccai Mario Gaudino Torsten Doenst |
| author_sort | Hristo Kirov |
| collection | DOAJ |
| description | Abstract Non-ST-elevation acute coronary syndrome (NSTE-ACS) affects millions of patients. Although an invasive strategy can improve survival, the optimal treatment [i.e., percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] is not clear. We performed a meta-analysis of studies reporting outcomes between PCI and CABG in patients with NSTE-ACS. MEDLINE, EMBASE and Cochrane Library were assessed. The primary outcome was long-term mortality. Inverse variance method and random model were performed. We identified 13 observational studies (48,891 patients). No significant difference was found in the primary endpoint [CABG vs. PCI, incidence rate ratio (IRR) 0.93, 95% confidence interval (CI) 0.70; 1.23]. CABG was associated with lower long-term major adverse cardiovascular events (MACE) (IRR 0.64, 95% CI 0.54; 0.76) and lower long-term re-revascularization (IRR 0.37, 95% CI 0.30; 0.47). There was no significant difference in long-term myocardial infarction (CABG vs. PCI, IRR 0.96, 95% CI 0.50; 1.84) and peri-operative mortality (CABG vs. PCI, odds ratio 1.36, 95% CI 0.94; 1.95). For the treatment of NSTE-ACS, CABG and PCI are associated with similar rates of long-term mortality and myocardial infarction. CABG is associated with lower rates of long-term MACE and re-revascularization. Randomized comparisons in this setting are necessary. |
| first_indexed | 2024-04-13T16:31:24Z |
| format | Article |
| id | doaj.art-6e71aa7362234d36974410b089833a2e |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-13T16:31:24Z |
| publishDate | 2022-03-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj.art-6e71aa7362234d36974410b089833a2e2022-12-22T02:39:33ZengNature PortfolioScientific Reports2045-23222022-03-011211810.1038/s41598-022-09158-0A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndromeHristo Kirov0Tulio Caldonazo1Mohamed Rahouma2N. Bryce Robinson3Michelle Demetres4Patrick W. Serruys5Giuseppe Biondi-Zoccai6Mario Gaudino7Torsten Doenst8Department of Cardiothoracic Surgery, Friedrich-Schiller-University JenaDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University JenaDepartment of Cardiothoracic Surgery at New York Presbyterian, Weill Cornell Medical CenterDepartment of Cardiothoracic Surgery at New York Presbyterian, Weill Cornell Medical CenterSamuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell MedicineDepartment of Cardiology, National University of Ireland, Galway (NUIG)Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of RomeDepartment of Cardiothoracic Surgery at New York Presbyterian, Weill Cornell Medical CenterDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University JenaAbstract Non-ST-elevation acute coronary syndrome (NSTE-ACS) affects millions of patients. Although an invasive strategy can improve survival, the optimal treatment [i.e., percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] is not clear. We performed a meta-analysis of studies reporting outcomes between PCI and CABG in patients with NSTE-ACS. MEDLINE, EMBASE and Cochrane Library were assessed. The primary outcome was long-term mortality. Inverse variance method and random model were performed. We identified 13 observational studies (48,891 patients). No significant difference was found in the primary endpoint [CABG vs. PCI, incidence rate ratio (IRR) 0.93, 95% confidence interval (CI) 0.70; 1.23]. CABG was associated with lower long-term major adverse cardiovascular events (MACE) (IRR 0.64, 95% CI 0.54; 0.76) and lower long-term re-revascularization (IRR 0.37, 95% CI 0.30; 0.47). There was no significant difference in long-term myocardial infarction (CABG vs. PCI, IRR 0.96, 95% CI 0.50; 1.84) and peri-operative mortality (CABG vs. PCI, odds ratio 1.36, 95% CI 0.94; 1.95). For the treatment of NSTE-ACS, CABG and PCI are associated with similar rates of long-term mortality and myocardial infarction. CABG is associated with lower rates of long-term MACE and re-revascularization. Randomized comparisons in this setting are necessary.https://doi.org/10.1038/s41598-022-09158-0 |
| spellingShingle | Hristo Kirov Tulio Caldonazo Mohamed Rahouma N. Bryce Robinson Michelle Demetres Patrick W. Serruys Giuseppe Biondi-Zoccai Mario Gaudino Torsten Doenst A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome Scientific Reports |
| title | A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome |
| title_full | A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome |
| title_fullStr | A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome |
| title_full_unstemmed | A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome |
| title_short | A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome |
| title_sort | systematic review and meta analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non st elevation acute coronary syndrome |
| url | https://doi.org/10.1038/s41598-022-09158-0 |
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