Article (Scientific journals)
Adverse events while awaiting myocardial revascularization: a systematic review and meta-analysis.
Head, Stuart J.; da Costa, Bruno R.; Beumer, Berend et al.
2017In European Journal of Cardio-Thoracic Surgery, 52 (2), p. 206-217
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Keywords :
Coronary artery bypass grafting; Death; Delay; Emergency revascularization; Myocardial infarction; Myocardial revascularization; Percutaneous coronary intervention; Wait list; Waiting
Abstract :
[en] OBJECTIVES: The aim of the current study was to estimate adverse event rates while awaiting myocardial revascularization and review criteria for prioritizing patients. METHODS: A PubMed search was performed on 19 January 2015, to identify English-language, original, observational studies reporting adverse events while awaiting coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Rates of death, non-fatal myocardial infarction (MI) and emergency revascularization were calculated as occurrence rates per 1000 patient-weeks and pooled using random-effects models. RESULTS: The search yielded 1323 articles, of which 22 were included with 66 410 patients and 607 675 patient-weeks on the wait list. When awaiting CABG, rates per 1000 patient-weeks were 1.1 [95% confidence interval 0.9-1.3] for death, 1.0 [0.6-1.6] for non-fatal MI and 1.8 [0.8-4.1] for emergency revascularization. Subgroup analyses demonstrated consistent outcomes, and sensitivity analyses demonstrated comparable event rates with low heterogeneity. Higher urgency of revascularization was based primarily on angiographic complexity, angina severity, left ventricular dysfunction and symptoms on stress testing, and such patients with a semi-urgent status had a higher risk of death than patients awaiting elective revascularization (risk ratio at least 2.8). Individual studies identified angina severity and left ventricular dysfunction as most important predictors of death when awaiting CABG. Adverse rates per 1000 patient-weeks for patients awaiting PCI were 0.1 [95% confidence interval 0.0-0.4] for death, 0.4 [0.1-1.2] for non-fatal MI and 0.7 [0.4-1.4] for emergency revascularization but were based on only a few old studies. CONCLUSIONS: Rates of death, non-fatal MI and emergency revascularization when awaiting myocardial revascularization are infrequent but higher in specific patients. Countries that not yet have treatment recommendations related to waiting times should consider introducing a maximum to limit adverse events, particularly when awaiting CABG.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Head, Stuart J.
da Costa, Bruno R.
Beumer, Berend
Stefanini, Giulio G.
Alfonso, Fernando
Clemmensen, Peter M.
Collet, Jean-Philippe
Cremer, Jochen
Falk, Volkmar
Filippatos, Gerasimos
Hamm, Christian
Kappetein, A. Pieter
Kastrati, Adnan
Knuuti, Juhani
Kolh, Philippe  ;  Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Biochimie et physiologie générales, humaines et path.
Landmesser, Ulf
Laufer, Gunther
Neumann, Franz-Josef
Richter, Dimitrios J.
Schauerte, Patrick
Taggart, David P.
Torracca, Lucia
Valgimigli, Marco
Wijns, William
Witkowski, Adam
Windecker, Stephan
Juni, Peter
Sousa-Uva, Miguel
More authors (18 more) Less
Language :
English
Title :
Adverse events while awaiting myocardial revascularization: a systematic review and meta-analysis.
Publication date :
2017
Journal title :
European Journal of Cardio-Thoracic Surgery
ISSN :
1010-7940
eISSN :
1873-734X
Publisher :
Elsevier, Netherlands
Volume :
52
Issue :
2
Pages :
206-217
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 23 November 2017

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