PMID- 30196030
OWN - NLM
STAT- MEDLINE
DCOM- 20200615
LR  - 20231006
IS  - 1878-0938 (Electronic)
IS  - 1553-8389 (Print)
IS  - 1878-0938 (Linking)
VI  - 20
IP  - 7
DP  - 2019 Jul
TI  - Network Meta-Analysis of Percutaneous Intervention-Based Revascularization 
      Strategies for ST-Elevation Myocardial Infarction and Concomitant Multi-Vessel 
      Disease.
PG  - 603-611
LID - S1553-8389(18)30394-4 [pii]
LID - 10.1016/j.carrev.2018.08.018 [doi]
AB  - BACKGROUND: In patients with ST elevation myocardial infarction (STEMI) and 
      concomitant multi-vessel disease (MVD), primary percutaneous coronary 
      intervention (PCI) of the culprit vessel is the preferred reperfusion strategy. 
      However, optimum timing of revascularization for non-culprit artery is unclear. 
      In this Bayesian network meta-analysis (NMA), we compared different PCI-based 
      revascularization strategies in STEMI patients with MVD. METHODS: 11 randomized 
      controlled trials (RCTs) were selected using MEDLINE, EMBASE and CENTRAL 
      (Inception to September 2017). For all outcomes, median estimate of odds ratio 
      from posterior distribution with corresponding 95% credible interval was 
      calculated. The Surface under the Cumulative Ranking Curve (SUCRA) metric was 
      used to estimate the relative ranking probability of each intervention. 
      Sensitivity analysis was conducted by excluding the RCTs in which the staged 
      intervention was performed after two weeks of the index procedure or post 
      discharge. RESULTS: In this NMA of 3172 patients, CR-I (instant complete 
      revascularization) was associated with 40% relative risk reduction in all-cause 
      mortality compared with IRA (infarct related artery) [0.60 (0.31-0.89)]. CR-I was 
      superior to CR-S (staged complete revascularization) [0.42 (0.22-0.70)] and IRA 
      [0.50(0.29-0.72)] in reducing the risk of re- infarction. Both CR-I and CR-S 
      significantly reduced the risk of repeat revascularization compared to IRA, 
      whereas the risk of CIN (contrast induced nephropathy) and major bleeding was 
      similar across all interventions. Sensitivity analysis showed, that CR-I was a 
      better strategy compared with CR-S [0.34 (0.12-0.74)] and IRA (0.60 [0.36-0.97]) 
      in reducing all-cause mortality. CONCLUSIONS: In this NMA, CR-I was associated 
      with reduction in all-cause mortality and re- infarction compared with IRA.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Fatima, Urooj
AU  - Fatima U
AD  - Howard University Hospital, United States of America. Electronic address: 
      ufatima@huhosp.org.
FAU - Khan, Safi U
AU  - Khan SU
AD  - West Virginia University, United States of America.
FAU - Akanbi, Olabisi
AU  - Akanbi O
AD  - Howard University Hospital, United States of America.
FAU - Girotra, Saket
AU  - Girotra S
AD  - University of Iowa Hospitals and Clinics, United States of America.
FAU - Opoku-Asare, Isaac
AU  - Opoku-Asare I
AD  - Howard University Hospital, United States of America.
LA  - eng
GR  - U54 GM104942/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20180828
PL  - United States
TA  - Cardiovasc Revasc Med
JT  - Cardiovascular revascularization medicine : including molecular interventions
JID - 101238551
SB  - IM
MH  - Aged
MH  - Cause of Death
MH  - Coronary Artery Disease/diagnostic imaging/mortality/*therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Network Meta-Analysis
MH  - *Percutaneous Coronary Intervention/adverse effects/mortality
MH  - Randomized Controlled Trials as Topic
MH  - Recurrence
MH  - Risk Factors
MH  - ST Elevation Myocardial Infarction/diagnostic imaging/mortality/*therapy
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC6426681
MID - NIHMS1005210
OTO - NOTNLM
OT  - Multi-vessel disease
OT  - Revascularization
OT  - STEMI
EDAT- 2018/09/10 06:00
MHDA- 2020/06/17 06:00
PMCR- 2020/07/01
CRDT- 2018/09/10 06:00
PHST- 2018/07/24 00:00 [received]
PHST- 2018/08/23 00:00 [revised]
PHST- 2018/08/23 00:00 [accepted]
PHST- 2018/09/10 06:00 [pubmed]
PHST- 2020/06/17 06:00 [medline]
PHST- 2018/09/10 06:00 [entrez]
PHST- 2020/07/01 00:00 [pmc-release]
AID - S1553-8389(18)30394-4 [pii]
AID - 10.1016/j.carrev.2018.08.018 [doi]
PST - ppublish
SO  - Cardiovasc Revasc Med. 2019 Jul;20(7):603-611. doi: 10.1016/j.carrev.2018.08.018. 
      Epub 2018 Aug 28.