PMID- 36004105
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220826
IS  - 2666-2736 (Electronic)
IS  - 2666-2736 (Linking)
VI  - 8
DP  - 2021 Dec
TI  - Comparison of invasive treatment strategies in patients with non-ST elevation 
      acute coronary syndrome: A systematic review and meta-analysis.
PG  - 323-335
LID - 10.1016/j.xjon.2021.08.028 [doi]
AB  - OBJECTIVE: To compare the mortality associated with percutaneous coronary 
      intervention (PCI) and coronary artery bypass grafting (CABG) in patients with 
      non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS: We searched 
      publications from PubMed, Embase, Web of Science, and the Cochrane Library from 
      inception until December 23, 2020. All randomized clinical trials (RCTs) and 
      observational studies comparing all-cause mortality after treatment with CABG 
      versus PCI for patients with NSTE-ACS with minimum follow-up of 6 months were 
      included. Restricted mean survival time (RMST) differences from RCTs and adjusted 
      RMST differences from observational studies were computed by reconstructing 
      time-to-event data from published Kaplan-Meier curves. Extracted hazard ratios 
      (HRs) were also assessed as a secondary analysis. RESULTS: Our systematic review 
      included an individual participant data analysis of 3 RCTs and 8 observational 
      studies. A meta-regression showed a significant association between 
      log-transformed HRs and duration of follow-up (-0.009 [95% confidence interval 
      (CI), -0.002 to -0.016] log-HR per 1-year longer follow-up; P = .037), suggesting 
      a violation of the proportional hazard assumption. Analysis of 6 studies with 
      available RMST data showed a significant inverse association between adjusted 
      RMST differences and cutoff years (slope, -0.028 [95% CI, -0.042 to -0.013] year 
      difference per 1-year longer cutoff; P < .005), suggesting a longer survival 
      benefit in the CABG arm compared with the PCI arm with longer follow-up. 
      CONCLUSIONS: There was a trend toward a benefit of CABG compared with PCI in the 
      longer follow-up in patients with NSTE-ACS. A large, well-designed RCT with 
      longer follow-up is needed to obtain definitive evidence on this topic.
CI  - (c) 2021 The Author(s).
FAU - Hamaya, Rikuta
AU  - Hamaya R
AD  - Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, 
      Mass.
AD  - Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Mass.
AD  - Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 
      Tokyo, Japan.
FAU - Chang, Yuan Ting
AU  - Chang YT
AD  - Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, 
      Mass.
FAU - Chewcharat, Api
AU  - Chewcharat A
AD  - Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, 
      Mass.
FAU - Chiu, Nicholas
AU  - Chiu N
AD  - Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, 
      Mass.
FAU - Yonetsu, Taishi
AU  - Yonetsu T
AD  - Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 
      Tokyo, Japan.
FAU - Kakuta, Tsunekazu
AU  - Kakuta T
AD  - Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, 
      Ibaraki, Japan.
FAU - Papatheodorou, Stefania
AU  - Papatheodorou S
AD  - Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, 
      Mass.
LA  - eng
PT  - Journal Article
DEP - 20210908
PL  - Netherlands
TA  - JTCVS Open
JT  - JTCVS open
JID - 101768541
PMC - PMC9390253
OTO - NOTNLM
OT  - CABG, coronary artery bypass grafting
OT  - CI, confidence interval
OT  - DES, drug-eluting stent
OT  - HR, hazard ratio
OT  - MVD, multivessel disease
OT  - NSTE-ACS, non-ST elevation acute coronary syndrome
OT  - PCI, percutaneous coronary intervention
OT  - RCT, randomized controlled trial
OT  - RMST, restricted mean survival time
OT  - all-cause mortality
OT  - coronary artery bypass grafting
OT  - meta-analysis
OT  - non-ST elevation acute coronary syndrome
OT  - percutaneous coronary intervention
EDAT- 2022/08/26 06:00
MHDA- 2022/08/26 06:01
PMCR- 2021/09/08
CRDT- 2022/08/25 02:31
PHST- 2021/01/04 00:00 [received]
PHST- 2021/08/20 00:00 [accepted]
PHST- 2022/08/25 02:31 [entrez]
PHST- 2022/08/26 06:00 [pubmed]
PHST- 2022/08/26 06:01 [medline]
PHST- 2021/09/08 00:00 [pmc-release]
AID - S2666-2736(21)00258-8 [pii]
AID - 10.1016/j.xjon.2021.08.028 [doi]
PST - epublish
SO  - JTCVS Open. 2021 Sep 8;8:323-335. doi: 10.1016/j.xjon.2021.08.028. eCollection 
      2021 Dec.