Survival and Cardiac Remodeling Benefits in Patients Undergoing Late Percutaneous Coronary Intervention of the Infarct-Related Artery: Evidence From a Meta-Analysis of Randomized Controlled Trials
Our purpose was to perform a systematic review and meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) with medical therapy in patients randomized >12 h after acute myocardial infarction (AMI).
Background
There is ongoing uncertainty about the risk–benefit ratio of late PCI in stable patients with AMI.
Methods
PubMed, CENTRAL, and other databases were searched (July 2007). Studies were included if they compared PCI with medical management and randomized patients >12 h and up to 60 days after AMI, and were excluded if patients were hemodynamically unstable. Odds ratios (ORs) were pooled for dichotomous outcomes, with all-cause mortality as the primary end point. Left cardiac remodeling parameters were also pooled with generic inverse-variance weighting.
Results
We retrieved 10 studies that enrolled 3,560 patients, with median time from AMI to randomization of 12 days (range 1 to 26 days), and follow-up of 2.8 years (42 days to 10 years). Randomization allocated 1,779 subjects to PCI and 1,781 to medical treatment. There were 112 (6.3%) and 149 (8.4%) deaths in the 2 groups, respectively, yielding significantly improved survival in the PCI group (OR 0.49 [95% confidence interval (CI) 0.26 to 0.94], p = 0.030). These benefits were associated with similarly favorable effects on cardiac remodeling, such as improved left ventricular ejection fraction in the PCI group (+4.4% change [95% CI 1.1 to 7.6], p = 0.009).
Conclusions
Percutaneous coronary intervention of the IRA performed late (12 h to 60 days) after AMI is associated with significant improvements in cardiac function and survival.
Abbreviations and Acronyms
AMI
acute myocardial infarction
CI
confidence interval
IRA
infarct-related artery
LVEF
left ventricular ejection fraction
LVEDVI
left ventricular end-diastolic volume index
LVESVI
left ventricular end-systolic volume index
OR
odds ratio
PCI
percutaneous coronary intervention
RCT
randomized controlled trial
RD
risk difference
RR
relative risk
Cited by (0)
Dr. Agostoni has received lecture fees from Cordis Belgium and Jolife Inc.; Dr. Biondi-Zoccai has consulted for Boston Scientific, Cordis, and Mediolanum Cardio Research, and has received lecture fees from Bristol-Myers Squibb; Dr. Vetrovec was on the December 2006 FDA panel for drug-eluting stents and has received various research and/or teaching grants, honoraria, consulting fees and/or stock in the following corporations over the past 5 years: Pfizer, Cordis/Johnson&Johnson, CV Therapeutics, Boston Scientific, Medtronic, Schering-Plough, and Abbott Labs; it should be noted that the U.S. FDA did not identify a substantial conflict of interest (to preclude his participation) to the December 2006 Panel Meeting for drug-eluting stents. This study is part of a training project of the Meta-analysis and Evidence-based Training in Cardiology (METCARDIO) Center, Richmond, Virginia. Drs. Abbate, Biondi-Zoccai, and Appleton contributed equally to this work.
