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Physiology or Angiography-Guided Coronary Artery Bypass Grafting: A Meta-Analysis
José Martins1, Vera Afreixo2, Luís Santos1
1Baixo Vouga Hospital Centre, Aveiro - Portugal.
Insights
This meta-analysis found that physiology-guided coronary artery bypass grafting (CABG) may reduce all-cause death compared to angiography-guided CABG. However, further research with longer follow-up is needed to confirm these findings for coronary artery disease management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Coronary angiography is standard for diagnosing coronary artery disease (CAD).
- Coronary physiology-guided revascularization is a modern standard for managing intermediate CAD.
- Long-term outcomes comparing physiology-guided versus angiography-guided coronary artery bypass grafting (CABG) remain uncertain.
Purpose of the Study:
- To compare clinical outcomes between physiology-guided CABG and angiography-guided CABG.
- To assess the efficacy of physiology-guided revascularization in CABG procedures.
Main Methods:
- A systematic literature search was conducted in Medline, EMBASE, and the Cochrane Library up to June 2020.
- A pooled risk-ratio meta-analysis evaluated all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), and major adverse cardiovascular events (MACE).
- Statistical significance was set at P<0.05, with heterogeneity assessed using Cochran's Q test and I2 index.
Main Results:
- Five studies comprising 1,114 patients were included.
- No significant differences were observed in MI (RR=0.72), TVR (RR=1.25), or MACE (RR=0.81) between the two strategies.
- A trend towards reduced all-cause death was noted with physiology-guided CABG (RR=0.63), though not statistically significant (p=0.55).
Conclusions:
- Physiology-guided CABG demonstrated a potential reduction in all-cause death.
- Limitations include short follow-up periods, small sample sizes, and lack of cause-of-death discrimination.
- Further studies with extended follow-up are necessary to establish definitive conclusions on physiology-guided CABG outcomes.
Background:
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. This meta-analysis aims to assess the clinical outcomes of a physiology guided CABG compared to the angiography-guided CABG.
Objectives:
We sought to determine if outcomes differ between a physiology guided CABG compared to an angiography-guided CABG.
Methods:
We searched Medline, EMBASE, and the Cochrane Library. The last date for this search was June 2020, and all of the previous studies were included. We conducted a pooled risk-ratio meta-analysis for four main outcomes: all-cause death, myocardial infarction (MI), target vessel revascularization (TVR) and major adverse cardiovascular events (MACE). P-value <0.05 was considered as statistically significant. Heterogeneity was assessed with Cochran's Q test and quantified by the I2 index.
Results:
We identified five studies that included a total of 1,114 patients. A pooled meta-analysis showed no significant difference between a physiology 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). The physiology guided strategy has 0.63 times the risk of all-cause death compared to the angiography-guided strategy (RR = 0.63; 95%CI = 0.42-0.96; I2 = 0%; p = 0.55).
Conclusion:
This meta-analysis demonstrated a reduction in all-cause death when a physiology guided CABG strategy was used. Nevertheless, the short follow-up period, 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 period of observation are required to draw more robust and definitive conclusions.
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