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Coronary angiography- or fractional flow reserve-guided complete revascularization in multivessel disease STEMI : A Bayesian hierarchical network meta-analysis

Archilletti, Federico ; Ricci, Fabrizio LU ; Pelliccia, Francesco ; Dangas, George ; Giuliani, Livio ; Radico, Francesco ; Perfetti, Matteo ; Rossi, Serena ; Gallina, Sabina and Maddestra, Nicola , et al. (2023) In International Journal of Cardiology 370. p.122-128
Abstract

Aims: To identify the best strategy to achieve complete revascularization (CR) in patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). Methods and results: We systematically reviewed the literature for randomized controlled trials (RCTs) comparing IRA-only PCI and CR guided by angiography or fractional flow reserve (FFR) in MVD-STEMI. Both frequentist (classical) and Bayesian network meta-analysis were performed, including a comparative hierarchy estimation of the probability to reduce the primary composite endpoint of all-cause death and new myocardial infarction (MI). We identified 11 RCTs, including 8193 STEMI patients. Compared with IRA-only strategy, CR significantly reduced the primary endpoint... (More)

Aims: To identify the best strategy to achieve complete revascularization (CR) in patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). Methods and results: We systematically reviewed the literature for randomized controlled trials (RCTs) comparing IRA-only PCI and CR guided by angiography or fractional flow reserve (FFR) in MVD-STEMI. Both frequentist (classical) and Bayesian network meta-analysis were performed, including a comparative hierarchy estimation of the probability to reduce the primary composite endpoint of all-cause death and new myocardial infarction (MI). We identified 11 RCTs, including 8193 STEMI patients. Compared with IRA-only strategy, CR significantly reduced the primary endpoint (OR: 0.73; 95%CI0.55–0.97). We observed non-significant difference between angiography and FFR guidance in reducing the primary endpoint (OR: 0.73, 95% CI 0.35–1.57). The Bayesian probability analysis ranked angio-guided CR as the best intervention yielding lowest risk of all-cause death or new MI (SUCRA92%). Conclusions: In patients with MVD-STEMI, CR is associated with a reduction in all-cause mortality and new MI compared with IRA-only PCI. Angio-guided CR is associated with the lowest risk of all-cause death or new MI, therefore the role of FFR-guidance in this setting is questionable. Condensed abstract: Both frequentist and Bayesian network meta-analysis were performed to compare infarct-related artery (IRA)-only percutaneous coronary intervention (PCI) and complete revascularization (CR) guided by angiography or fractional flow reserve (FFR) in multivessel disease (MVD) and acute ST-elevation myocardial infarction (STEMI). Eleven randomized controlled trials were identified, including 8193 STEMI patients. Compared with IRA-only strategy, CR significantly reduced the incidence of the composite endpoint of all-cause death and new myocardial infarction without significant difference in angio-guided and FFR-guided CR. The Bayesian probability analysis ranked angio-guided CR as the best intervention yielding lowest risk of the composite endpoint and, therefore the role of FFR-guidance in this setting is questionable.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute myocardial infarction, Complete revascularization, Percutaneous coronary intervention
in
International Journal of Cardiology
volume
370
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:85143505949
  • pmid:36328114
ISSN
0167-5273
DOI
10.1016/j.ijcard.2022.10.170
language
English
LU publication?
yes
id
4f927420-6ffd-408f-b916-76199f5e4680
date added to LUP
2023-01-30 10:58:25
date last changed
2024-06-09 12:12:52
@article{4f927420-6ffd-408f-b916-76199f5e4680,
  abstract     = {{<p>Aims: To identify the best strategy to achieve complete revascularization (CR) in patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). Methods and results: We systematically reviewed the literature for randomized controlled trials (RCTs) comparing IRA-only PCI and CR guided by angiography or fractional flow reserve (FFR) in MVD-STEMI. Both frequentist (classical) and Bayesian network meta-analysis were performed, including a comparative hierarchy estimation of the probability to reduce the primary composite endpoint of all-cause death and new myocardial infarction (MI). We identified 11 RCTs, including 8193 STEMI patients. Compared with IRA-only strategy, CR significantly reduced the primary endpoint (OR: 0.73; 95%CI0.55–0.97). We observed non-significant difference between angiography and FFR guidance in reducing the primary endpoint (OR: 0.73, 95% CI 0.35–1.57). The Bayesian probability analysis ranked angio-guided CR as the best intervention yielding lowest risk of all-cause death or new MI (SUCRA92%). Conclusions: In patients with MVD-STEMI, CR is associated with a reduction in all-cause mortality and new MI compared with IRA-only PCI. Angio-guided CR is associated with the lowest risk of all-cause death or new MI, therefore the role of FFR-guidance in this setting is questionable. Condensed abstract: Both frequentist and Bayesian network meta-analysis were performed to compare infarct-related artery (IRA)-only percutaneous coronary intervention (PCI) and complete revascularization (CR) guided by angiography or fractional flow reserve (FFR) in multivessel disease (MVD) and acute ST-elevation myocardial infarction (STEMI). Eleven randomized controlled trials were identified, including 8193 STEMI patients. Compared with IRA-only strategy, CR significantly reduced the incidence of the composite endpoint of all-cause death and new myocardial infarction without significant difference in angio-guided and FFR-guided CR. The Bayesian probability analysis ranked angio-guided CR as the best intervention yielding lowest risk of the composite endpoint and, therefore the role of FFR-guidance in this setting is questionable.</p>}},
  author       = {{Archilletti, Federico and Ricci, Fabrizio and Pelliccia, Francesco and Dangas, George and Giuliani, Livio and Radico, Francesco and Perfetti, Matteo and Rossi, Serena and Gallina, Sabina and Maddestra, Nicola and Khanji, Mohammed Y. and Zimarino, Marco}},
  issn         = {{0167-5273}},
  keywords     = {{Acute myocardial infarction; Complete revascularization; Percutaneous coronary intervention}},
  language     = {{eng}},
  pages        = {{122--128}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Cardiology}},
  title        = {{Coronary angiography- or fractional flow reserve-guided complete revascularization in multivessel disease STEMI : A Bayesian hierarchical network meta-analysis}},
  url          = {{http://dx.doi.org/10.1016/j.ijcard.2022.10.170}},
  doi          = {{10.1016/j.ijcard.2022.10.170}},
  volume       = {{370}},
  year         = {{2023}},
}