Survival and Cardiac Remodeling Benefits in Patients Undergoing Late Percutaneous Coronary Intervention of the Infarct-Related ArteryEvidence From a Meta-Analysis of Randomized Controlled Trials
Antonio Abbate, MD*,*,
Giuseppe G.L. Biondi-Zoccai, MD ,
Darryn L. Appleton, MBChB*,
Paul Erne, MD ,
Andreas W. Schoenenberger, MD ,
Michael J. Lipinski, MD||,
Pierfrancesco Agostoni, MD¶,
Imad Sheiban, MD and
George W. Vetrovec, MD, FACC*
* Virginia Commonwealth University–VCU Pauley Heart Center, Richmond, Virginia
Division of Cardiology, University of Turin, Turin, Italy
Division of Cardiology, Kantonsspital Luzern, Luzern, Switzerland
Department of Internal Medicine, University Hospital of Berne, Berne, Switzerland
|| Department of Internal Medicine, University of Virginia, Charlottesville, Virginia
¶ Antwerp Cardiovascular Institute Middelheim, Antwerp, Belgium.
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Figure 1 Individual and Pooled Risks of Adverse Outcomes
Forest plots showing individual and pooled risks of death (A), death, and nonfatal recurrent myocardial infarction (B), death, nonfatal recurrent myocardial infarction, or rehospitalization for angina/heart failure (C), and nonfatal recurrent myocardial infarction (D) comparing late percutaneous coronary intervention (PCI) versus best medical therapy (Rx) only for infarct-related artery occlusion late (>12 h) in the course of acute myocardial infarction. ALKK = Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte; BRAVE-2 = Beyond 12 Hours Reperfusion Alternative Evaluation Trial; CI = confidence interval; DEPOCI = Randomized Trial of Occluded Artery Angioplasty After Acute Myocardial Infarction; OAT = Occluded Artery Trial; OR = odds ratio; SWISSI II = Swiss Interventional Study on Silent Ischemia Type II; TOAT = The Occluded Artery Trial; TOMIIS = Total Occlusion Post-Myocardial Infarction Intervention Study; TOPS = Treatment of Post-thrombolytic Stenoses.
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Figure 2 Individual and Pooled Group Differences in Changes in Cardiac Function and Remodeling
Forest plot showing individual and pooled changes in left ventricular ejection fraction, end-diastolic volume index, and end-systolic volume index at follow-up comparing late PCI versus best medical therapy only for infarct-related artery occlusion late (>12 h) in the course of acute myocardial infarction. (A) Shows a +4% change in left ventricular ejection fraction favoring PCI. (B and C) Show a significant greater decrease in left ventricular end-diastolic volume index and left ventricular end-systolic volume index in the PCI, showing a more favorable remodeling pattern with PCI. TOSCA-2 = Total Occlusion Study of Canada; other abbreviations as in Figure 1.
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Figure 3 Lack of Small Study Bias
Funnel plot of study effect (odds ratio) versus precision (standard error of log-transformed odds ratio) suggests the lack of small study bias (p = 0.896 at Peters’ test).
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Figure 4 Correlation Between Length of Follow-Up and Changes in Cardiac Function
Meta-regression represents interaction between lengths of follow-up and observed changes in left ventricular ejection fraction (LVEF), showing greater benefits of late percutaneous coronary intervention with increasing duration of follow-up (p = 0.001).
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