scholarly journals Thiazolidinediones and Risk of Repeat Target Vessel Revascularization Following Percutaneous Coronary Intervention: A meta-analysis

Diabetes Care ◽  
2007 ◽  
Vol 30 (2) ◽  
pp. 384-388 ◽  
Author(s):  
D. M. Riche ◽  
R. Valderrama ◽  
N. N. Henyan
Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ashraf Alazzoni ◽  
Ayman Al-Saleh ◽  
Sanjit S. Jolly

Background. Individual randomized trials have suggested that everolimus-eluting stents may have improved clinical outcomes compared to paclitaxel-eluting stents, but individual trials are underpowered to examine outcomes such as mortality and very late stent thrombosis. Methods. Medline, Cochrane, and conference proceedings were searched for randomized trials comparing everolimus versus paclitaxel-eluting stents for percutaneous coronary intervention. Results. 6792 patients were included from 4 randomized controlled trials. Stent thrombosis was reduced with everolimus stents versus paclitaxel stents (0.7% versus 2.3%; OR: 0.32; CI: 0.20–0.51; P<0.00001). The reductions in stent thrombosis were observed in (i) early stent thrombosis (within 30 days) (0.2% versus 0.9%; OR: 0.24; P=0.0005), (ii) late (day 31–365) (0.2% versus 0.6%; OR: 0.32; P=0.01), and (iii) very late stent thrombosis (>365 days) (0.2% versus 0.8%; OR: 0.34; P=0.009). The rates of cardiovascular mortality were 1.2% in everolimus group and 1.6% in paclitaxel group (OR: 0.85; P=0.43). Patients receiving everolimus-eluting stents had significantly lower myocardial infarction events and target vessel revascularization as compared to paclitaxel-eluting stents. Interpretation. Everolimus compared to paclitaxel-eluting stents reduced the incidence of early, late, and very late stent thrombosis as well as target vessel revascularization.


2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Yan Li ◽  
Xiying Liang ◽  
Wenjiao Zhang ◽  
Xuan Qiao ◽  
Zhilu Wang

Objective. The effect of postdilation in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of postdilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods. PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wangfang databases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with postdilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes comprised all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, and the angiographic outcomes were no reflow and slow reflow. Results. 11 studies met inclusion criteria. In clinical outcomes, our pooled analysis demonstrated that the postdilation had a tendency of decreasing MACE (OR = 0.67, 95% CI 0.45–1.00; P  = 0.05) but significantly increased all-cause death (OR = 1.49, 95% CI 1.05–2.12; P  = 0.03). No significant difference existed in stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P  = 0.24), myocardial infarction (OR = 1.40, 95% CI 0.51–3.83; P  = 0.51), and target vessel revascularization (OR = 0.61, 95% CI 0.21–1.80; P  = 0.37) between postdilation and non-postdilation groups. In angiographic outcomes, there were no significant differences in no reflow (OR = 1.19, 95% CI 0.54–2.65; P  = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; P  = 0.24) between two groups. Conclusions. The postdilation tends to reduce the risk of MACE but significantly increases all-cause death, without significantly affecting stent thrombosis, myocardial infarction, target vessel revascularization, and coronary TIMI flow grade. However, more randomized controlled trials are required for investigating the effect of postdilation for patients with acute coronary syndrome (registered by PROSPERO, CRD42020160748).


2020 ◽  
Author(s):  
Yan Li ◽  
Xiying Liang ◽  
Wenjiao Zhang ◽  
Xuan Qiao ◽  
Zhilu Wang

Abstract Background Optimal stent deployment is closely related to the prognosis of patients with coronary artery disease, but the effect of post-dilation on clinical and angiographic outcomes in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods PubMed, Embase, The Cochrane Library, Web of Science, CNKI and WANGFANG date-bases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with post-dilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes were comprised of all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, the angiographic outcomes were no reflow and slow reflow. Results A total of 11 studies enrolling 5663 patients met inclusion criteria. Our pooled analysis demonstrated that the post-dilation did not have significant impact on MACE (OR = 0.76, 95% CI 0.50–1.17; P = 0.21), stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P = 0.24), myocardial infarction (OR = 0.14, 95% CI 0.51–3.83; P = 0.51), and target vessel revascularization of clinical outcomes (OR = 0.61, 95% CI 0.21–1.80; P = 0.37) between post-dilation and non-post-dilation groups, but increased the risk of all-cause death (OR = 1.49, 95% CI 1.05–2.19; P = 0.03). There were no significant difference in no reflow (OR = 1.19, 95% CI 0.54–2.65; P = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; P = 0.24) of angiographic outcomes between two groups. Conclusions The post-dilation can increase the risk of all-cause death, without affecting the risks of MACE, stent thrombosis, myocardial infarction, target vessel revascularization, no reflow and slow reflow. However, more randomized controlled trials are required for investigating the benefits of post-dilation for patients with acute coronary syndrome (Registered by PROSPERO, CRD42020160748).


Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yassir Nawaz ◽  
Jurga Adomaityte ◽  
Zishan K Siddiqui ◽  
Muhammed Amer ◽  
Rehan Qayyum

Background: Facilitated percutaneous coronary intervention (PCI), in which pharmacological agents are administered before coronary angiography, may result in early restoration of myocardial perfusion and can improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). To examine whether facilitated PCI is associated with better myocardial perfusion and clinical outcomes than primary PCI, we performed a meta-analysis of the clinical trials that compared the two strategies. Methods: PubMed, EMBASE, and The Cochrane Collaboration databases were searched through June 2008. We included clinical trials that were published in English language peer-reviewed medical journals and randomized patients with STEMI to facilitated or primary PCI. Two investigators independently abstracted data. Random-effects model was used to pool results. Results: Of the 419 identified articles, 24 were included (total patients =7997, facilitated PCI =4409, primary PCI =3588, median age=61 years, males=78%). Facilitated PCI increased myocardial perfusion as measured by grade 2 and/or 3 myocardial blush (588 vs. 468, OR=1.66, 95%CI=1.19 to 2.32) and ST segment resolution (1021 vs. 790, OR=1.61, 95%CI=1.25 to 2.09) as compared to primary PCI. Facilitated PCI was similar to primary PCI in reducing mortality (238 vs. 215, OR=1.10, 95%CI=0.88 to 1.37), reinfarction (129 vs. 109, OR=1.16, 95%CI=1.16(0.87 to 1.55), target vessel revascularization (181 vs. 144, OR=1.34, 95%CI=0.88 to 2.04), and stroke (51 vs. 24, OR=1.99, 95%CI=0.85 to 4.66). However, facilitated PCI was associated with increased incidence of major bleeding (236 vs. 151, OR=1.42, 95%CI=1.12, 1.81). Conclusion: As compared to primary PCI, facilitated PCI is associated with early restoration of myocardial perfusion, but has no effect on overall mortality, reinfarction, target vessel revascularization, and stroke, and increases risk of major bleeding in patients with STEMI. Results of meta-analysis comparing facilitated and primary percutneous coronary intervention


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