TY - JOUR
T1 - Assessment of Repeat Revascularization in Percutaneous Coronary Intervention Randomized Controlled Trials as a Surrogate for Mortality
T2 - A Meta-Regression Analysis
AU - Khan, Safi U.
AU - Lone, Ahmad N.
AU - Akbar, Usman Ali
AU - Arshad, Hassaan B.
AU - Arshad, Adeel
AU - Arora, Shilpkumar
AU - Kaluski, Edo
AU - Aoun, Joe
AU - Goel, Sachin S.
AU - Shah, Alpesh R.
AU - Kleiman, Neal S.
N1 - Funding Information:
The authors declare that all supporting data are available within the article (and its Supplementary files). Conception and design: S. U. Khan. Analysis and interpretation of the data: S. U. Khan and A. N. Lone. Drafting of the article: S. U. Khan and N. S. Kleiman. Critical revision of the article for important intellectual content: S. U. Khan, A. N. Lone, U. A. Akbar, H. B. Arshad, S. Arora, E. Kaluski, J. Aoun, S. S. Goel, A. Shah, N. S. Kleiman. Final approval of the article: S. U. Khan, A. N. Lone, U. A. Akbar, H. B. Arshad, S. Arora, E. Kaluski, J. Aoun, S. S. Goel, A. Shah, N. S. Kleiman. Provision of study materials or patients: S. U. Khan, A. N. Lone. Statistical expertise: S. U. Khan. Collection and assembly of data: S. U. Khan, A. N. Lone, U. A. Akbar. S. U. Khan is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Publisher Copyright:
© 2022
PY - 2023/4
Y1 - 2023/4
N2 - The association of repeat revascularization after percutaneous coronary intervention (PCI) with mortality is uncertain. To assess the association of repeat revascularization after PCI with mortality in patients with coronary artery disease (CAD). We identified randomized controlled trials comparing PCI with coronary artery bypass graft (CABG) or optimal medical therapy (OMT) using electronic databases through January 1, 2022. We performed a random-effects meta-regression between repeat revascularization rates after PCI (absolute risk difference [%] between PCI and CABG or OMT) with the relative risks (RR) of mortality. We assessed surrogacy of repeat revascularization for mortality using the coefficient of determination (R2), with threshold of 0.80. In 33 trials (21,735 patients), at median follow-up of 4 (2-7) years, repeat revascularization was higher after PCI than CABG [RR: 2.45 (95% confidence interval, 1.99-3.03)], but lower vs OMT [RR: 0.64 (0.46-0.88)]. Overall, meta-regression showed that repeat revascularization rates after PCI had no significant association with all-cause mortality [RR: 1.01 (0.99-1.02); R2=0.10) or cardiovascular mortality [RR: 1.01 (CI: 0.99-1.03); R2=0.09]. In PCI vs CABG (R2=0.0) or PCI vs OMT trials (R2=0.28), repeat revascularization did not meet the threshold for surrogacy for all-cause or cardiovascular mortality (R2=0.0). We observed concordant results for subgroup analyses (enrollment time, follow-up, sample size, risk of bias, stent types, and coronary artery disease), and multivariable analysis adjusted for demographics, comorbidities, risk of bias, MI, and follow-up duration. In summary, this meta-regression did not establish repeat revascularization after PCI as a surrogate for all-cause or cardiovascular mortality.
AB - The association of repeat revascularization after percutaneous coronary intervention (PCI) with mortality is uncertain. To assess the association of repeat revascularization after PCI with mortality in patients with coronary artery disease (CAD). We identified randomized controlled trials comparing PCI with coronary artery bypass graft (CABG) or optimal medical therapy (OMT) using electronic databases through January 1, 2022. We performed a random-effects meta-regression between repeat revascularization rates after PCI (absolute risk difference [%] between PCI and CABG or OMT) with the relative risks (RR) of mortality. We assessed surrogacy of repeat revascularization for mortality using the coefficient of determination (R2), with threshold of 0.80. In 33 trials (21,735 patients), at median follow-up of 4 (2-7) years, repeat revascularization was higher after PCI than CABG [RR: 2.45 (95% confidence interval, 1.99-3.03)], but lower vs OMT [RR: 0.64 (0.46-0.88)]. Overall, meta-regression showed that repeat revascularization rates after PCI had no significant association with all-cause mortality [RR: 1.01 (0.99-1.02); R2=0.10) or cardiovascular mortality [RR: 1.01 (CI: 0.99-1.03); R2=0.09]. In PCI vs CABG (R2=0.0) or PCI vs OMT trials (R2=0.28), repeat revascularization did not meet the threshold for surrogacy for all-cause or cardiovascular mortality (R2=0.0). We observed concordant results for subgroup analyses (enrollment time, follow-up, sample size, risk of bias, stent types, and coronary artery disease), and multivariable analysis adjusted for demographics, comorbidities, risk of bias, MI, and follow-up duration. In summary, this meta-regression did not establish repeat revascularization after PCI as a surrogate for all-cause or cardiovascular mortality.
KW - Humans
KW - Coronary Artery Disease/therapy
KW - Percutaneous Coronary Intervention/methods
KW - Randomized Controlled Trials as Topic
KW - Coronary Artery Bypass/methods
KW - Regression Analysis
KW - Treatment Outcome
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U2 - 10.1016/j.cpcardiol.2022.101555
DO - 10.1016/j.cpcardiol.2022.101555
M3 - Review article
C2 - 36529233
AN - SCOPUS:85145817574
SN - 0146-2806
VL - 48
SP - 101555
JO - Current Problems in Cardiology
JF - Current Problems in Cardiology
IS - 4
M1 - 101555
ER -