Complete revascularization did not reduce mortality or MI but increased major bleeding risk (RR 2.43) versus culprit-lesion-only PCI in diabetic MI patients.
Does complete revascularization improve clinical outcomes compared to culprit-lesion-only revascularization in patients with myocardial infarction and diabetes?
In patients with myocardial infarction and diabetes, complete revascularization does not significantly reduce mortality or cardiovascular events compared to culprit-lesion-only PCI, but it significantly increases the risk of major bleeding.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Recent clinical evidence suggests that complete revascularization, compared to culprit-lesion-only, might improve clinical outcomes. Diabetes is a strong and independent predictor of poor cardiovascular outcomes in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI). Purpose This systematic review and meta-analysis aimed to evaluate the differences in outcomes following complete versus culprit-lesion-only revascularization in patients with myocardial infarction and diabetes. Methods A systematic literature search of the major bibliographic databases (PubMed, Embase, Cochrane Central, and Web of Science) was performed to identify relevant observational studies and randomized controlled trials (RCTs). Risk ratios (RR) with 95% CIs were pooled using the Mantel-Haenszel random effects model to calculate effect estimates. Statistical significance was set at p0.05. Results 6 studies (4 observational and 2 RCTs) with 5079 patients with diabetes undergoing PCI were included complete = 2371 and culprit-lesion-only = 2708. The mean ages and sex distribution were comparable between the two groups complete = 61.7±10.82 (males = 67.8%) and culprit-lesion-only = 62.29±10.7 (males = 67.9%). Other comorbidities were also comparable (complete versus culprit-lesion-only) between the two groups: hypertension (73% vs 73.3%), previous MI (11.7% vs 12.5%), and dyslipidemia (63.3% vs 60.2%). On pooled analysis, no significant differences in the risks of all-cause mortality RR:0.68; 95% CI: 0.46-1.01; p=0.05, cardiovascular mortality RR:1.12; 95% CI: 0.74-1.69; p=0.60, MI RR:0.78; 95% CI: 0.57-1.08; p=0.13, urgent PCI RR:0.62; 95% CI: 0.34-1.13; p=0.12, stroke RR:1.06; 95% CI: 0.52-2.16; p=0.88, and major adverse cardiovascular events RR:0.61; 95% CI: 0.13-2.83; p=0.53 were noted between the two groups. However, complete revascularization was associated with a significantly higher risk of major bleeding RR:2.43; 95% CI: 1.17-5.08; p=0.02 than culprit-lesion-only revascularization. Conclusion This meta-analysis concludes that complete and culprit-lesion-only revascularization poses comparable cardiovascular risks for diabetic patients undergoing PCI. Large-scale RCTs with standardized reporting are warranted to validate these results.
Jain et al. (Sat,) reported a other. Complete revascularization did not reduce mortality or MI but increased major bleeding risk (RR 2.43) versus culprit-lesion-only PCI in diabetic MI patients.