Document Detail


Percutaneous Coronary Intervention versus Optimal Medical Therapy for Prevention of Spontaneous Myocardial Infarction in Subjects with Stable Ischemic Heart Disease.
MedLine Citation:
PMID:  23325526     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Contemporary studies have shown that spontaneous but not procedural myocardial infarction (MI) are related to subsequent mortality. Whether PCI reduces spontaneous (non-procedural) MI is unknown. METHODS AND RESULTS: PUBMED, EMBASE, and CENTRAL were searched for randomized clinical trials (RCTs), until October 2012, comparing PCI with OMT, for stable ischemic heart disease, and reporting MI outcomes - spontaneous non-procedural MI, procedural MI and all MI including procedure related MI. Given the varying length of follow-up between trials, a mixed-effect poisson regression meta-analysis was employed. From 12 RCTs with 37548 patient-years of follow-up, PCI, when compared with OMT alone, was associated with significant lower incident rate ratio (IRR) for spontaneous non-procedural MI (IRR=0.76, 95% CI 0.58-0.99) at the risk of higher procedural MI (IRR=4.11, 95% CI 2.53-6.88) without any difference in all MI (IRR=0.96, 95% CI 0.74-1.21). The point estimate for PCI vs. OMT for all-cause mortality (IRR=0.88, 95% CI 0.75-1.03) and cardiovascular mortality (IRR=0.70, 95% CI 0.44-1.09) paralleled that of spontaneous non-procedural MI (but not procedural or all nonfatal MI) although these were not statistically significant. CONCLUSIONS: PCI compared to OMT reduced spontaneous MI at the risk of procedural MI without any difference in all MI. Consistent with prior studies showing that spontaneous MI but not procedural MI are related to subsequent mortality, in the present report the point estimate for reduced mortality with PCI compared to OMT paralleled the prevention of spontaneous MI with PCI. Further studies are needed to determine whether these associations are causal.
Authors:
Sripal Bangalore; Seema Pursnani; Sunil Kumar; Pantelis G Bagos
Related Documents :
11501966 - Heart metastases from gastric sarcoma. a case report.
6983316 - Cardiovascular effects of nalbuphine in patients with coronary or valvular heart disease.
11887046 - Mitral valve replacement in ischemic mitral regurgitation. preservation of both anterio...
21199236 - Cardiovascular protection afforded by caloric restriction: essential role of nitric oxi...
17640536 - Pathophysiology of acute myocardial infarction.
19147456 - The clinical utility of brain natriuretic peptide in paediatric left ventricular failure.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-16
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 New York University School of Medicine, New York, NY.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Percutaneous Left Atrial Appendage Closure for Stroke Prophylaxis in Patients with Atrial Fibrillati...
Next Document:  Diclofenac: New data on chronic toxicity and bioconcentration in fish.