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Physiology versus Angiography-Guided Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis
Session:
Sessão de Posters 29 - Intervenção coronária percutânea
Speaker:
Ana L. Silva
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Ana L. Silva; Mariana Rodrigues Simões; Tatiana Pereira Dos Santos; Gonçalo Terleira Batista; Diogo de Almeida Fernandes; Joana Guimarães; Gonçalo Ferraz Costa; Eric Monteiro; Rafaela Fernandes; José Luís Martins; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> While invasive coronary angiography is considered the gold standard for the diagnosis of coronary artery disease (CAD) involving the epicardial coronary vessels, coronary physiology-guided revascularization represents a contemporary gold-standard 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 – coronary artery bypass grafting (CABG) are still uncertain.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>We searched Medline, EMBASE, and the Cochrane Library until December 2023, including all previous studies. We aimed to assess the clinical outcomes of a physiology-guided CABG compared to the angiography-guided CABG. A pooled odds-ratio meta-analysis was conducted focusing on five main outcomes: all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), major adverse cardiovascular events (MACE), and postoperative angina. A pooled effect estimates meta-analysis was performed with MetaXL 2.0.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> We identified six studies that included a total of 18,849 patients. The follow-up ranged from 6 months to 6 years. A pooled meta-analysis showed no significant difference between physiology and angiography-guided strategies in all-cause death (odds ratio [OR] = 0.80; 95%CI = 0.50–1.28; I<sup>2</sup> = 20%; p = 0.28), MACE (OR = 0.78; 95%CI = 0.55–1.09; I<sup>2</sup> = 0%; p = 0.99), MI (OR = 0.95; 95%CI, 0.70–1.29; I<sup>2</sup> = 0%; p = 0.61), and TVR (OR = 1.17; 95%CI = 0.91–1.51; I<sup>2</sup> = 0%; p = 0.67). The rates of postoperative angina were also similar in both approaches (OR = 1.71; 95%CI = 0.39-7.38; I<sup>2</sup> = 0%; p = 0.32).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> This meta-analysis suggests that physiology-guided and angiography-guided CABG strategies exhibit comparable clinical outcomes, questioning the role of coronary physiology in surgical patients. Further research is needed to address this clinical concern.</span></span></p>
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