Cardiology

Meta-analysis supports elective revascularization and medical therapy for reducing cardiac death

The ISCHEMIA trial found no significant difference between an invasive vs. a conservative strategy in patients with chronic coronary syndromes and moderate to severe ischemia at a mean of 3.2 years. However, the cumulative difference in the estimates of cardiac death between the invasive and conservative strategies tended to increase numerically over time (e.g., 0.3% in favor of the invasive strategy at two years and 1.3% at five years). Because the ISCHEMIA trial was not powered for cardiac mortality and did not focus on long-term follow-up, the rationale for a meta-analysis emerged.

At EuroPCR 2021, Navarese and colleagues present the results of a new meta-analysis of revascularization plus medical therapy versus medical therapy alone. A total of 19,806 patients with chronic coronary syndromes undergoing elective revascularization from 25 randomised trials were pooled, and outcomes were extracted at the longest available follow-up. The primary endpoint was cardiac death. Secondary endpoints were all-cause death, spontaneous myocardial infarction, any myocardial infarction and stroke.

The authors found a statistically significant 21% relative risk reduction in cardiac death with revascularization plus medical therapy (risk ratio 0.79, 95% confidence interval 0.67 to 0.93, p

There was a parallel significant reduction in spontaneous myocardial infarction with revascularization plus medical therapy (risk ratio 0.74, 95% confidence interval 0.64 to 0.86, pmyocardial infarction. No difference was noted in all the other secondary outcomes, including all-cause death.

Overall, this meta-analysis suggests that the benefits of revascularization and optimised medical therapy are additive, and their combination is required to achieve maximal and durable prevention of adverse events.


Study: ISCHEMIA trial represents small fraction of patients undergoing intervention


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Meta-analysis supports elective revascularization and medical therapy for reducing cardiac death (2021, May 18)
retrieved 18 May 2021
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