PMID- 32614851
OWN - NLM
STAT- MEDLINE
DCOM- 20200908
LR  - 20200908
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 15
IP  - 7
DP  - 2020
TI  - Immediate versus deferred percutaneous coronary intervention for patients with 
      acute coronary syndrome: A meta-analysis of randomized controlled trials.
PG  - e0234655
LID - 10.1371/journal.pone.0234655 [doi]
LID - e0234655
AB  - Inconsistent results exist regarding the treatment effectiveness of immediate 
      versus deferred percutaneous coronary intervention (PCI) in patients with acute 
      coronary syndrome (ACS). This meta-analysis aimed to evaluate the efficacy and 
      safety of immediate versus deferred PCI in ACS patients. PubMed, EMBASE, and 
      Cochrane Library electronic databases were systematically searched from their 
      inception up to August 2019. Random-effects models were employed to calculate 
      pooled relative risks (RRs) and weight mean differences (WMDs) with 95% 
      confidence intervals (CIs). A total of 10 randomized controlled trials (RCTs) 
      that recruited 3350 patients were selected for inclusion in the final 
      meta-analysis. Four trials included patients with non-ST elevation ACS (NSTEACS), 
      whereas the remaining six trials included patients with ST elevation myocardial 
      infarction (STEMI). There were no significant differences between immediate 
      versus deferred PCI for the risk of major adverse cardiovascular events (NSTEACS 
      patients: RR, 0.76, 95%CI, 0.33-1.75, P = 0.513; STEMI patients: RR, 1.24, 95%CI, 
      0.80-1.92, P = 0.335), myocardial infarction (NSTEACS patients: RR, 0.88, 95%CI, 
      0.27-2.81, P = 0.826; STEMI patients: RR, 0.86, 95%CI, 0.43-1.74, P = 0.678), 
      all-cause mortality (NSTEACS patients: RR, 0.85, 95%CI, 0.38-1.88, P = 0.686; 
      STEMI patients: RR, 1.16, 95%CI, 0.82-1.66, P = 0.407), target vessel 
      revascularisation (NSTEACS patients: RR, 1.26, 95%CI, 0.29-5.43, P = 0.756; STEMI 
      patients: RR, 1.01, 95%CI, 0.51-1.97, P = 0.988), or major bleeding (NSTEACS 
      patients: RR, 0.99, 95%CI, 0.64-1.54, P = 0.972; STEMI patients: RR, 0.90, 95%CI, 
      0.45-1.77, P = 0.753). Although patients who underwent immediate PCI may 
      experience increased incidences of cardiac death (RR, 1.19, 95%CI, 0.69-2.07, P = 
      0.525) and no or slow reflow (RR, 1.60, 95%CI, 0.91-2.84, P = 0.105), these 
      increases were not statistically significant. We noted that immediate versus 
      deferred PCI was associated with a reduced incidence of myocardial brush grade 3 
      (RR, 0.70, 95%CI, 0.56-0.88, P = 0.002); however, no significant differences were 
      observed between immediate and deferred PCI for TIMI III flow (RR, 0.98, 95%CI, 
      0.93-1.03, P = 0.453), complete ST-segment resolution (RR, 0.93, 95%CI, 
      0.75-1.17, P = 0.548), and ejection fraction (WMD, -1.05, 95%CI, -2.58 to 0.49, P 
      = 0.182). The findings of this study suggested that deferred PCI did not yield 
      significant benefits for clinical endpoints. Further large-scale RCTs should be 
      conducted to verify the findings of this study.
FAU - Li, Weijun
AU  - Li W
AUID- ORCID: 0000-0002-8103-3300
AD  - Department of Cardiovascular Diseases of the Elderly, Chenzhou First People's 
      Hospital, Chenzhou, China.
FAU - He, Wenhua
AU  - He W
AD  - Department of Cardiovascular Diseases of the Elderly, Chenzhou First People's 
      Hospital, Chenzhou, China.
FAU - Zhou, Yuqing
AU  - Zhou Y
AD  - Department of Cardiovascular Diseases of the Elderly, Chenzhou First People's 
      Hospital, Chenzhou, China.
FAU - Guo, Yanfei
AU  - Guo Y
AD  - Department of Cardiovascular Diseases of the Elderly, Chenzhou First People's 
      Hospital, Chenzhou, China.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20200702
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Acute Coronary Syndrome/*surgery
MH  - Aged
MH  - Cause of Death
MH  - Death
MH  - Humans
MH  - Middle Aged
MH  - Mortality
MH  - Myocardial Infarction/epidemiology
MH  - Myocardial Reperfusion
MH  - *Percutaneous Coronary Intervention/adverse effects/statistics & numerical data
MH  - Postoperative Complications/epidemiology
MH  - Postoperative Hemorrhage/epidemiology
MH  - Randomized Controlled Trials as Topic
MH  - Risk
MH  - Stroke Volume
MH  - *Time-to-Treatment
MH  - Treatment Outcome
PMC - PMC7332029
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/07/03 06:00
MHDA- 2020/09/09 06:00
PMCR- 2020/07/02
CRDT- 2020/07/03 06:00
PHST- 2019/10/10 00:00 [received]
PHST- 2020/05/31 00:00 [accepted]
PHST- 2020/07/03 06:00 [entrez]
PHST- 2020/07/03 06:00 [pubmed]
PHST- 2020/09/09 06:00 [medline]
PHST- 2020/07/02 00:00 [pmc-release]
AID - PONE-D-19-28194 [pii]
AID - 10.1371/journal.pone.0234655 [doi]
PST - epublish
SO  - PLoS One. 2020 Jul 2;15(7):e0234655. doi: 10.1371/journal.pone.0234655. 
      eCollection 2020.