Department of Medicine, The Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Catheter Cardiovasc Interv. 2020 Oct 1;96(4):E447-E454. doi: 10.1002/ccd.28855. Epub 2020 Mar 28.
Whether revascularization should be performed as multivessel intervention at the time of index procedure (MV-index), staged procedure (MV-staged), or culprit only intervention (COI) in patients with multivessel disease (MVD) presenting with acute coronary syndrome (ACS) is unclear. We performed a systematic review and network meta-analysis of randomized controlled trials to assess the optimal revascularization strategy in this patient population.
PubMed, Embase, and Cochrane Central databases were systematically searched to identify all relevant studies. The outcomes assessed were major cardiac adverse events (MACE), all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and revascularization. A Bayesian random-effects network meta-analysis was used to calculate odds ratio (OR) with credible interval (CrI).
Thirteen studies with 8,066 patients were included in the analysis. There was a decreased risk of MACE (MV-index vs. COI: OR, 0.35; 95% CrI, 0.23-0.55; MV-staged vs COI: OR, 0.52; 95% CrI, 0.31-0.81) and revascularization (MV-index vs. COI: OR, 0.27; 95% CrI, 0.15-0.49; MV-staged vs. COI: OR, 0.38; 95% CrI, 0.19-0.70) with MV-index intervention and MV-staged intervention compared with COI. However, MV-index intervention and not MV-staged intervention was associated with a decreased risk of MI (MV-index vs. COI: OR, 0.35; 95% CrI, 0.12-0.93; MV-staged vs. COI: OR, 0.65; 95% CrI, 0.24-1.59) compared with COI.
Our analysis suggests that multivessel intervention either at index procedure or as staged intervention may be more efficacious compared to COI in patients with MVD presenting with ACS.
对于伴有急性冠脉综合征（ACS）的多血管疾病（MVD）患者，在指数程序（MV-index）时进行多血管介入治疗、分期程序（MV-staged）还是仅罪犯血管介入治疗（COI），目前尚不清楚哪种策略更优。我们进行了一项系统评价和网络荟萃分析，以评估该患者群体的最佳血运重建策略。
系统检索了 PubMed、Embase 和 Cochrane Central 数据库，以确定所有相关研究。评估的结局包括主要心脏不良事件（MACE）、全因死亡率、心血管死亡率、心肌梗死（MI）和血运重建。采用贝叶斯随机效应网络荟萃分析计算比值比（OR）及其可信区间（CrI）。
共纳入 13 项研究，总计 8066 例患者。MV-index 组与 COI 组相比，MACE 风险降低（OR，0.35；95%CrI，0.23-0.55；MV-staged 组与 COI 组相比，OR，0.52；95%CrI，0.31-0.81）和血运重建风险降低（OR，0.27；95%CrI，0.15-0.49；MV-staged 组与 COI 组相比，OR，0.38；95%CrI，0.19-0.70）；但 MV-index 组与 COI 组相比，MI 风险降低（OR，0.35；95%CrI，0.12-0.93；MV-staged 组与 COI 组相比，OR，0.65；95%CrI，0.24-1.59）。
与 COI 相比，在伴有 ACS 的 MVD 患者中，MV-index 或 MV-staged 多血管介入治疗可能比 COI 更有效。
