PMID- 33085752
OWN - NLM
STAT- Publisher
LR  - 20240222
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
DP  - 2020 Oct 21
TI  - Treatment strategies in ischaemic left ventricular dysfunction: a network 
      meta-analysis.
LID - ezaa319 [pii]
LID - 10.1093/ejcts/ezaa319 [doi]
AB  - OBJECTIVES: The optimal revascularization strategy for patients with ischaemic 
      left ventricular systolic dysfunction (iLVSD) remains controversial. We aimed to 
      compare percutaneous coronary intervention (PCI), coronary artery bypass grafting 
      (CABG) and medical therapy (MT) in a network meta-analysis. METHODS: All 
      randomized controlled trials and observational studies comparing any combination 
      of PCI, CABG and MT in patients with iLVSD were analysed in a frequentist network 
      meta-analysis (generic inverse variance method). Primary outcome was mortality at 
      longest available follow-up. Secondary outcomes were cardiac death, stroke, 
      myocardial infarction (MI) and repeat revascularization (RR). RESULTS: 
      Twenty-three studies were included (n = 23 633; 4 randomized controlled trials). 
      Compared to CABG, PCI was associated with higher mortality [incidence rate ratio 
      (IRR) 1.32, 95% confidence interval (CI) 1.13-1.53], cardiac death (IRR 1.65, 95% 
      CI 1.18-2.33), MI (IRR 2.18, 95% CI 1.70-2.80) and RR (IRR 3.75, 95% CI 
      2.89-4.85). Compared to CABG, MT was associated with higher mortality (IRR 1.52, 
      95% CI 1.26-1.84), cardiac death (IRR 3.83, 95% CI 2.12-6.91), MI (IRR 3.22, 95% 
      CI 1.52-6.79) and RR (IRR 3.37, 95% CI 1.67-6.79). Compared to MT, PCI was 
      associated with lower cardiac death (IRR 0.43, 95% CI 0.24-0.78). CABG ranked as 
      the best revascularization strategy for mortality, cardiac death, MI and RR; MT 
      ranked as the strategy associated with the lowest incidence of stroke. Left 
      ventricular ejection fraction, year of study, use of drug-eluting stents did not 
      affect relative treatment effects. CONCLUSIONS: CABG appears to be the best 
      therapy for iLVSD, although mainly based on observational data. Definitive 
      randomized controlled trials comparing CABG and PCI in iLVSD are required. 
      PROSPERO REGISTRATION ID: 132414.
CI  - (c) The Author(s) 2020. Published by Oxford University Press on behalf of the 
      European Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Gaudino, Mario
AU  - Gaudino M
AD  - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
FAU - Hameed, Irbaz
AU  - Hameed I
AD  - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
FAU - Khan, Faiza M
AU  - Khan FM
AD  - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
FAU - Tam, Derrick Y
AU  - Tam DY
AD  - Schulich Heart Centre, Sunnybrook Health Science University of Toronto, Toronto, 
      ON, Canada.
FAU - Rahouma, Mohamed
AU  - Rahouma M
AD  - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
FAU - Yongle, Ruan
AU  - Yongle R
AD  - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
FAU - Naik, Ajita
AU  - Naik A
AD  - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
FAU - Di Franco, Antonino
AU  - Di Franco A
AD  - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
FAU - Demetres, Michelle
AU  - Demetres M
AD  - Samuel J. Wood Library and C.V. Starr Biomedical Information Centre, Weill 
      Cornell Medicine, New York, NY, USA.
FAU - Petrie, Mark C
AU  - Petrie MC
AD  - Institute of Cardiovascular and Medical Sciences, British Heart Foundation 
      Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
FAU - Jolicoeur, E Marc
AU  - Jolicoeur EM
AD  - Montreal Heart Institute, Montreal, QC, Canada.
FAU - Girardi, Leonard N
AU  - Girardi LN
AD  - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
FAU - Fremes, Stephen E
AU  - Fremes SE
AD  - Schulich Heart Centre, Sunnybrook Health Science University of Toronto, Toronto, 
      ON, Canada.
LA  - eng
GR  - R01 HL152021/HL/NHLBI NIH HHS/United States
PT  - Journal Article
DEP - 20201021
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
OTO - NOTNLM
OT  - Coronary artery bypass grafting
OT  - Heart failure
OT  - Medical therapy
OT  - Percutaneous coronary intervention
OT  - Revascularization
EDAT- 2020/10/22 06:00
MHDA- 2020/10/22 06:00
CRDT- 2020/10/21 15:36
PHST- 2020/04/08 00:00 [received]
PHST- 2020/07/07 00:00 [revised]
PHST- 2020/07/29 00:00 [accepted]
PHST- 2020/10/21 15:36 [entrez]
PHST- 2020/10/22 06:00 [pubmed]
PHST- 2020/10/22 06:00 [medline]
AID - 5934675 [pii]
AID - 10.1093/ejcts/ezaa319 [doi]
PST - aheadofprint
SO  - Eur J Cardiothorac Surg. 2020 Oct 21:ezaa319. doi: 10.1093/ejcts/ezaa319.