Background Stroke is a rare but serious adverse event associated with percutaneous coronary intervention (PCI). However, the relative risk of stroke between stable patients undergoing a direct PCI strategy and those undergoing an initial optimal medical therapy (OMT) strategy has not been established yet. This study sought to investigate if, in patients with stable coronary artery disease (SCAD), an initial strategy PCI is associated with a higher risk of stroke than a strategy based on OMT alone. Methods We performed a meta-analysis of 6 contemporary randomized control trials in which 5673 patients with SCAD were randomized to initial PCI or OMT. Only trials with stent utilization more than 50% were included. Study endpoint was the rate of stroke during follow up. Results Mean age of patients ranged from 60 to 65 years and stent utilization ranged from 72% to 100%. Rate of stroke was 2.0% at a weighted mean follow up of 55.3 months. On pooled analysis, the risk of stroke was similar between patients undergoing a PCI plus OMT and those receiving only OMT (2.2% vs. 1.8%, OR on fixed effect = 1.24 95%CI: 0.85-1.79). There was no heterogeneity among the studies (I2 = 0.0%, P = 0.15). On sensitivity analysis after removing each individual study the pooled effect estimate remains unchanged. Conclusions In patients with SCAD an initial strategy based on a direct PCI is not associated with an increased risk of stroke during long-term follow up compared to an initial strategy based on OMT alone.

Taglieri, N., Reggiani, M.L.B., Ghetti, G., Saia, F., Dall'Ara, G., Gallo, P., et al. (2016). Risk of stroke in patients with stable coronary artery disease undergoing percutaneous coronary intervention versus optimal medical therapy: Systematic review and meta-analysis of randomized controlled trials. PLOS ONE, 11(7), e0158769-e0158769 [10.1371/journal.pone.0158769].

Risk of stroke in patients with stable coronary artery disease undergoing percutaneous coronary intervention versus optimal medical therapy: Systematic review and meta-analysis of randomized controlled trials

TAGLIERI, NEVIO;Reggiani, Maria Letizia Bacchi;Ghetti, Gabriele;Saia, Francesco;Dall'Ara, Gianni;Gallo, Pamela;Moretti, Carolina;Palmerini, Tullio;Marzocchi, Antonio;RAPEZZI, CLAUDIO
2016

Abstract

Background Stroke is a rare but serious adverse event associated with percutaneous coronary intervention (PCI). However, the relative risk of stroke between stable patients undergoing a direct PCI strategy and those undergoing an initial optimal medical therapy (OMT) strategy has not been established yet. This study sought to investigate if, in patients with stable coronary artery disease (SCAD), an initial strategy PCI is associated with a higher risk of stroke than a strategy based on OMT alone. Methods We performed a meta-analysis of 6 contemporary randomized control trials in which 5673 patients with SCAD were randomized to initial PCI or OMT. Only trials with stent utilization more than 50% were included. Study endpoint was the rate of stroke during follow up. Results Mean age of patients ranged from 60 to 65 years and stent utilization ranged from 72% to 100%. Rate of stroke was 2.0% at a weighted mean follow up of 55.3 months. On pooled analysis, the risk of stroke was similar between patients undergoing a PCI plus OMT and those receiving only OMT (2.2% vs. 1.8%, OR on fixed effect = 1.24 95%CI: 0.85-1.79). There was no heterogeneity among the studies (I2 = 0.0%, P = 0.15). On sensitivity analysis after removing each individual study the pooled effect estimate remains unchanged. Conclusions In patients with SCAD an initial strategy based on a direct PCI is not associated with an increased risk of stroke during long-term follow up compared to an initial strategy based on OMT alone.
2016
Taglieri, N., Reggiani, M.L.B., Ghetti, G., Saia, F., Dall'Ara, G., Gallo, P., et al. (2016). Risk of stroke in patients with stable coronary artery disease undergoing percutaneous coronary intervention versus optimal medical therapy: Systematic review and meta-analysis of randomized controlled trials. PLOS ONE, 11(7), e0158769-e0158769 [10.1371/journal.pone.0158769].
Taglieri, Nevio; Reggiani, Maria Letizia Bacchi; Ghetti, Gabriele; Saia, Francesco; Dall'Ara, Gianni; Gallo, Pamela; Moretti, Carolina; Palmerini, Tul...espandi
File in questo prodotto:
File Dimensione Formato  
plosone.pdf

accesso aperto

Descrizione: Plos One
Tipo: Versione (PDF) editoriale
Licenza: Licenza per Accesso Aperto. Creative Commons Attribuzione - Non commerciale (CCBYNC)
Dimensione 1.08 MB
Formato Adobe PDF
1.08 MB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/565446
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 2
  • ???jsp.display-item.citation.isi??? 2
social impact