期刊
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
卷 86, 期 -, 页码 S15-S22出版社
WILEY
DOI: 10.1002/ccd.26025
关键词
myocardial infarction; randomized trials; percutaneous coronary intervention
IntroductionDuring primary percutaneous coronary intervention (PCI), patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease can undergo either multivessel intervention (MVI) or culprit-vessel intervention (CVI) only. BackgroundRandomized controlled trials (RCTs) support the use of MVI, but cohort studies support the use of CVI. MethodsWe developed Bayesian models that incorporated parameters for study type and study outcome after MVI or CVI. ResultsA total of 18 studies (4 RCTs, 3 matched cohort studies, and 11 unmatched observational studies) enrolled 48,398 patients with STEMI and multivessel CAD and reported outcomes after MVI or CVI-only at the time of primary PCI. Using a Bayesian hierarchical model, we found that the point estimates replicated previously reported trends, but the wide Bayesian credible intervals (BCI) excluded any plausible mortality difference between MVI versus CVI in all three study types: RCTs (odds ratio [OR] 0.60, 95% BCI 0.31-1.20), matched cohort studies (OR 1.37, 95% BCI 0.86-2.24), or unmatched cohort studies (OR 1.16, 95% BCI 0.70-1.89). Both the global summary (OR 1.10, 95% BCI 0.74-1.51) and a sensitivity analysis that weighted the RCTs 1-5 times as much as observational studies revealed no credible advantage of one PCI strategy over the other (OR 1.05, 95% BCI 0.64-1.48). ConclusionsBayesian approaches contextualize the comparison of different strategies by study type and suggest that neither MVI nor CVI emerges as a preferred strategy in an analysis that accounts mortality differences. (c) 2015 Wiley Periodicals, Inc.
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