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Physiologic or Angiography guided Coronary Artery Bypass Grafting: a meta-analysis
Session:
Prémio Machado Macedo/ CO 15- Cardiac Surgery
Speaker:
Diana Vale Carvalho
Congress:
CPC 2021
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.1 Invasive Imaging and Functional Assessment
Session Type:
Prémios
FP Number:
---
Authors:
Diana Vale Carvalho; Jose Luis Martins; Vera Afreixo; Luis Santos; Pedro Carvalho; Lisa Ferraz; Adriana Pacheco; Raquel Ferreira; Ana Briosa
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><em><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">Background</span></span></em></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">While <span style="background-color:white">invasive coronary angiography is considered the <em>gold standard</em> for the diagnosis of coronary artery disease (CAD) involving the epicardial coronary vessels, coronary physiology-guided revascularization represents contemporary <em>gold-standard</em> practice for the invasive management of patients with intermediate CAD. Nevertheless, the long-term results of assessing the severity of stenosis through physiology compared to the angiogram as the guide to bypass surgery (CABG) are still uncertain. </span>This meta-analysis aims to assess the clinical outcomes of a <span style="background-color:white">physiology guided CABG compared to angiography-guided CABG.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><em><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">Objectives</span></span></em></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">We sought to determine if outcomes differ between </span></span><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">a <span style="background-color:white">physiology guided CABG compared to angiography-guided CABG</span>.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><em><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">Methods</span></span></em></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">We searched Medline, EMBASE, and the Cochrane Library. </span></span><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">The last date for this search was June 2020, and all preceding studies were included in the search. We conducted a pooled risk-ratio meta-analysis for 4 main outcomes: all cause death, </span></span><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">myocardial infarction (MI), target vessel revascularization (TVR) and major adverse cardiovascular events (MACE). </span></span><em><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">P-</span></span></em><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">value <0.05 was considered statistically significant. Heterogeneity was assessed with Cochran’s Q score and </span></span><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">quantified by I</span></span><span style="font-size:7.5pt"><span style="font-family:"Calibri",sans-serif">2 </span></span><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">index.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><em><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">Results</span></span></em></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">We identified 5 studies that included a total of 1114</span></span><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif"> patients. A pooled meta-analysis showed no significant difference between a physiologic guided strategy and an angiography guided strategy in MI (risk ratio [RR] = 0.72; 95% CI, 0.39–1.33; I2 = 0%; p = 0.65), TVR (RR = 1.25; 95% CI = 0.73–2.13; I2 = 0%; p = 0.52), or MACE (RR = 0.81; 95% CI = 0.62–1.07; I2 = 0%; p = 1). Physiologic guided strategy has 0.63 times the risk of all cause death compared to angiography guided strategy (RR = 0.63; 95% CI = 0.42–0.96; I2 = 0%; p = 0.55).</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><em><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion</span></span></em></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">This meta-analysis demonstrates a reduction in all cause death when a physiologic guided CABG strategy was used.<strong> </strong><span style="background-color:white">Nevertheless, the short follow-up, small sample size of the included studies and the non-discrimination of the causes of death can largely justify these conclusions. Studies with an extended follow-up observation are needed to more robustly draw definitive conclusions.</span></span></span></span></span></p>
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