A Meta-analysis Of The Efficacy And Safety Of Complete Revacularization In Patiens With Acute Coronary Syndrome

ObjectiveTo evaluate the efficacy and safety of complete revascularization(MV-PCI)and partial revascularization(CV-PCI)in patients with acute coronary syndrome.MethodAvailable data from clinical randomized controlled trials of different revascularization methods to prevent acute coronary syndrome since database building untill November2018 were retrieved,which includes Pubmed,Embase,Cochrane Collaboration and CNKI,WF Data,VIP database.Screening and inclusion of high-quality literature that meets the requirements and the relevant data from the literatures obtained were then screened and analyzed.Using Rev Man5.3 software system to evaluate the efficacy of different revascularization methods for the treatment of coronary multivessel disease,such as: average hospitalization days,infarct vascular opening time,contrast agent dosage,average Contrast time,platelet GPIIb/IIIa receptor antagonist use rate,mean stent number,IABP use rate,etc.;and safety,such as: incidence of contrast nephropathy,perioperative complications,incidence of bleeding events,stents Thrombosis rate,all-cause mortality,major cardiovascular adverse events,angina recurrence rate,re-PCI incidence,heart failure rehospitallization rate,cardiac mortality,recurrence of CABG,and incidence of cerebral infarction.ResultA total of 25 literatures were included,involving 146857 patients with acute coronary syndrome combined multi-vessel disease in 13 regions including China,the United States,Britain and France.Meta-analysis results showed that compared with partial revascularization(CV-PCI)which only PCI for criminal vessels,complete revascularization(MV-PCI)significantly reduced mean hospital stay(MD=-4.27,95% CI-5.1～-3.44,P<0.00001),no increasing perioperative vascular access time(MD=-0.64,95% CI-1.69～0.41,P=0.24),increasing the number of stents used by patients(MD=0.98,95%CI 0.88～1.09,P<0.00001)、use of platelet GPIIb/IIIa antagonists(RR=1.21,95%CI 1.15～1.27,P<0.00001)、Incidence of perioperative complications(RR=2.38,95%CI1.12～5.07,P=0.02)、contrast agent usage(MD=72.99,95%CI 33.24～112.73,P=0.0003)and contrast time(MD=7.27,95%CI 2.2～12.35,P=0.005),but the incidence of radiographic contrast nephropathy(RR=0.99,95%CI 0.51 to 1.92,P=0.98)、IABP usage(RR=1.02,95%CI 0.83～1.24,P=0.88)and perioperative bleeding events(RR=1.11,95% CI 0.84 to 1.46,P=0.48)were ineffective.During postoperative follow-up,MV-PCI significantly reduced all-cause mortality(OR=0.71,95% CI 0.58-0.88,P=0.001)and major cardiovascular events(OR=0.69,95% CI 0.52～0.93,P= 0.01),cardiac death(OR=0.49,95% CI 0.40～0.60,P<0.00001),recurrent angina(OR=0.25,95%CI 0.11～0.55,P=0.0007),heart failure re-hospitalization(OR=0.58,95%CI 0.48～0.70,P<0.00001)and decreased the incidence of PCI(OR=0.48,95%CI 0.34～0.69,P<0.0001)and CABG(OR=0.55,95% CI 0.29～1.03,P=0.06),no increase in myocardial infarction(OR=0.89,95% CI 0.61～1.31,P=0.56),stent thrombosis(OR=1.40,95%CI 0.94～2.07,P = 0.10),the risk of cerebral infarction(OR=0.82,95%CI0.54～1.25,P=0.35).ConclusionComplete revascularization(MV-PCI)can reduce mean hospitalization days in patients with acute coronary syndrome combined multi-vessel disease,although the amount of contrast agent,contrast time,average number of stents and the incidence of complications during the operation are increased,while the incidence of radiographic contrast nephropathy,perioperative bleeding events and the incidence of cardiogenic shock did not increase.During follow-up,complete revascularization(MV-PCI)significantly reduced all-cause mortality,cardiac mortality,and the incidence of major cardiovascular events,recurrent angina,recurrent PCI,and re-hospitalization rate in patients with multi-vessel disease.