PMID- 29909948
OWN - NLM
STAT- MEDLINE
DCOM- 20190722
LR  - 20190722
IS  - 1878-0938 (Electronic)
IS  - 1878-0938 (Linking)
VI  - 19
IP  - 6
DP  - 2018 Sep
TI  - Revascularization strategies in cardiogenic shock complicating acute myocardial 
      infarction: A systematic review and meta-analysis.
PG  - 647-654
LID - S1553-8389(18)30248-3 [pii]
LID - 10.1016/j.carrev.2018.06.004 [doi]
AB  - BACKGROUND: The optimal revascularization strategy in patients with multi-vessel 
      disease (MVD) presenting with acute myocardial infarction (AMI) and cardiogenic 
      shock (CS) remains unclear. OBJECTIVE: To investigate the comparative differences 
      between culprit-only revascularization (COR) versus instant multi-vessel 
      revascularization (IMVR) in AMI and CS. METHODS: 13 studies were selected using 
      MEDLINE, EMBASE and the CENTRAL (Inception - 31 November2017). Outcomes were 
      assessed at short-term (in-hospital or </=30 days duration) and long-term duration 
      (>/=6 months). Estimates were reported as random effects relative risk (RR) with 
      95% confidence interval (CI). RESULTS: In analysis of 7311 patients, COR 
      significantly reduced the relative risk of short-term all-cause mortality (RR: 
      0.87; 95% CI, 0.77-0.97; p = 0.01, I(2) = 50%) and renal failure (RR: 0.75; 95% 
      CI, 0.61-0.94; p = 0.01, I(2) = 7%) compared with IMVR. There were no significant 
      differences between both the strategies in terms of reinfarction (RR: 1.25; 95% 
      CI, 0.59-2.63; p = 0.56, I(2) = 0%), major bleeding (RR: 0.88; 95% CI, 0.75-1.04; 
      p = 0.14, I(2) = 0%) and stroke (RR: 0.77; 95% CI, 0.50-1.17; p = 0.22, 
      I(2) = 0%) at short term duration. Similarly, no significant differences were 
      observed between both groups regarding all-cause mortality (RR; 1.01; 95% CI, 
      0.85-1.20; p = 0.93, I(2) = 61%) and reinfarction (RR: 0.71; 95% CI, 0.34-1.47; 
      p = 0.35, I(2) = 26%) at long term duration. CONCLUSION: In MVD patients 
      presenting with AMI and CS, IMVR was comparable to COR in terms of all-cause 
      mortality at long term follow up duration. These results are predominantly 
      derived from observational data and more randomized controlled trials are 
      required to validate this impression.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Rahman, Hammad
AU  - Rahman H
AD  - Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA. Electronic address: 
      Hammad.Rahman@guthrie.org.
FAU - Khan, Safi U
AU  - Khan SU
AD  - Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA.
FAU - Lone, Ahmad N
AU  - Lone AN
AD  - Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA.
FAU - Kaluski, Edo
AU  - Kaluski E
AD  - Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA; Rutgers New Jersey 
      Medical School, Newark, NJ, USA; The Geisinger Commonwealth Medical College, 
      Scranton, PA, USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20180609
PL  - United States
TA  - Cardiovasc Revasc Med
JT  - Cardiovascular revascularization medicine : including molecular interventions
JID - 101238551
SB  - IM
CIN - Cardiovasc Revasc Med. 2018 Sep;19(6):645-646. PMID: 30268234
MH  - Aged
MH  - Aged, 80 and over
MH  - Cause of Death
MH  - Female
MH  - Hemorrhage/etiology/mortality
MH  - Humans
MH  - Kidney/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/mortality/physiopathology/*therapy
MH  - Myocardial Revascularization/adverse effects/*methods/mortality
MH  - Recurrence
MH  - Renal Insufficiency/etiology/mortality/physiopathology
MH  - Risk Assessment
MH  - Risk Factors
MH  - Shock, Cardiogenic/diagnosis/mortality/physiopathology/*therapy
MH  - Stroke/etiology/mortality
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Acute myocardial infarction
OT  - Cardiogenic shock
OT  - Culprit-only revascularization
OT  - Instant multi-vessel revascularization
EDAT- 2018/06/19 06:00
MHDA- 2019/07/23 06:00
CRDT- 2018/06/19 06:00
PHST- 2018/04/08 00:00 [received]
PHST- 2018/05/24 00:00 [revised]
PHST- 2018/06/06 00:00 [accepted]
PHST- 2018/06/19 06:00 [pubmed]
PHST- 2019/07/23 06:00 [medline]
PHST- 2018/06/19 06:00 [entrez]
AID - S1553-8389(18)30248-3 [pii]
AID - 10.1016/j.carrev.2018.06.004 [doi]
PST - ppublish
SO  - Cardiovasc Revasc Med. 2018 Sep;19(6):647-654. doi: 10.1016/j.carrev.2018.06.004. 
      Epub 2018 Jun 9.