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Cheema HA, Bhanushali K, Sohail A, Fatima A, Hermis AH, Titus A, Ahmad A, Majmundar V, Rehman WU, Sulaiman S, Lakhter V, Baron SJ, Dani SS. Immediate Versus Staged Complete Revascularization in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2024; 220:77-83. [PMID: 38582316 DOI: 10.1016/j.amjcard.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
A strategy of complete revascularization (CR) is recommended in patients with acute coronary syndrome (ACS) and multivessel disease (MVD). However, the optimal timing of CR remains equivocal. We searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing immediate CR (ICR) with staged CR in patients with ACS and MVD. Our primary outcomes were all-cause and cardiovascular mortality. All outcomes were assessed at 3 time points: in-hospital or at 30 days, at 6 months to 1 year, and at >1 year. Data were pooled in RevMan 5.4 using risk ratios as the effect measure. A total of 9 RCTs (7,506 patients) were included in our review. A total of 7 trials enrolled patients with ST-segment elevation myocardial infarction (STEMI), 1 enrolled patients with non-STEMI only, and 1 enrolled patients with all types of ACS. There was no difference between ICR and staged CR regarding all-cause and cardiovascular mortality at any time window. ICR reduced the rate of myocardial infarction and decreased the rate of repeat revascularization at 6 months and beyond. The rates of cerebrovascular events and stent thrombosis were similar between the 2 groups. In conclusion, the present meta-analysis demonstrated a lower rate of myocardial infarction and a reduction in repeat revascularization at and after 6 months with ICR strategy in patients with mainly STEMI and MVD. The 2 groups had no difference in the risk of all-cause and cardiovascular mortality. Further RCTs are needed to provide more definitive conclusions and investigate CR strategies in other ACS.
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Affiliation(s)
| | - Karan Bhanushali
- Department of Internal Medicine, Roger Williams Medical Center, Rhode Island
| | - Aruba Sohail
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Areej Fatima
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Anoop Titus
- Department of Preventive Cardiology, DeBakey Heart and Vasculature Center, Houston, Texas
| | - Adeel Ahmad
- Department of Internal Medicine, Mass General Brigham-Salem Hospital, Salem, Massachusetts
| | - Vidit Majmundar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Wajeeh Ur Rehman
- Department of Internal Medicine, United Health Services Hospital, Johnson City, New York
| | - Samian Sulaiman
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Vladimir Lakhter
- Cardiology Division, Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Suzanne J Baron
- Division of Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Baim Institute of Clinical Research, Boston, Massachusetts
| | - Sourbha S Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts.
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