EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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Although transcatheter aortic valve implantation (TAVI) is officially indicated for severe aortic stenosis (AS) patients at intermediate or higher surgical risk, the procedure is now increasingly being performed in patients who are at low surgical risk. Data on the benefit of TAVI in this patient population are limited. We therefore aimed to perform an updated meta-analysis of all published randomised controlled trials (RCTs) and propensity score-matched studies comparing TAVI versus surgical aortic valve replacement (SAVR) in patients at low surgical risk. ⋯ In patients who are at low surgical risk, TAVI seems to be associated with equivalent mortality up to a median follow-up of two years compared to SAVR. More data are required before TAVI can be routinely considered as an alternative to SAVR in low-risk patients.
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Meta Analysis Comparative Study
A comparison of multivessel and culprit vessel percutaneous coronary intervention in non-ST-segment elevation acute coronary syndrome patients with multivessel disease: a meta-analysis.
Percutaneous revascularisation triage has not been evaluated in randomised controlled trials of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel disease. As a result, current guidelines are not available. The objective of our meta-analysis was to investigate the use of percutaneous coronary intervention (PCI) in culprit and non-culprit vessels. ⋯ No significant difference was demonstrated in the long-term risk of myocardial infarction and mortality between multivessel PCI and culprit vessel PCI. Therefore, multivessel PCI may be a safe and reasonable option for NSTE-ACS patients with multivessel disease.
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Multicenter Study Meta Analysis
Bivalirudin versus heparin in patients treated with percutaneous coronary intervention: a meta-analysis of randomised trials.
Current recommendations on the use of bivalirudin in patients treated with percutaneous coronary intervention (PCI) are mostly based on trials comparing bivalirudin versus heparin plus planned glycoprotein IIb/IIIa inhibitor (GPI). Whether bivalirudin is also superior to heparin alone is still not well established. This meta-analysis investigates the efficacy and safety of bivalirudin versus heparin in patients treated with PCI without planned use of GPI. ⋯ Patients undergoing PCI randomised to therapy with either bivalirudin or heparin display a similar mortality. Bivalirudin as compared to heparin appears to reduce the risk of major bleeding at the expense of a higher risk of acute ST.
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Review Meta Analysis Comparative Study
Stenting strategy for coronary artery bifurcation with drug-eluting stents: a meta-analysis of nine randomised trials and systematic review.
The present study sought to compare angiographic and clinical outcomes of a simple strategy versus a complex strategy in patients with coronary bifurcation lesions undergoing drug-eluting stent implantation. ⋯ A complex strategy remains an optional treatment for patients with coronary bifurcation lesions without severe safety concerns. A complex strategy may be an optimal treatment for true bifurcation lesions with large side branches.
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Review Meta Analysis Comparative Study
Cangrelor versus clopidogrel in percutaneous coronary intervention: a systematic review and meta-analysis.
Cangrelor is a new antiplatelet agent that has been used in percutaneous coronary intervention (PCI) with mixed results. We aimed to review the evidence on the efficacy of cangrelor in comparison to clopidogrel in reducing ischaemic endpoints at 48 hours in patients undergoing PCI in large randomised trials. ⋯ Based on this meta-analysis, we did not find any difference in the risk of the primary composite efficacy endpoint of all-cause death, ischaemia-driven revascularisation, and myocardial infarction at 48hours between cangrelor and clopidogrel use. Given that cangrelor was associated with a lower risk of stent thrombosis, ischaemia-driven revascularisation and Q-wave myocardial infarction compared to clopidogrel, cangrelor can be considered as a suitable alternative during PCI.