PREDICTORS OF ADVERSE EVENTS IN PATIENTS WITH UNPROTECTED  LEFT MAIN DISEASE TREATED WITH DRUG-ELUTI...
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PREDICTORS OF ADVERSE EVENTS IN PATIENTS WITH UNPROTECTED LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION. G. BIONDI-ZOCCAI 1 , C. MORETTI 1 , E. MELIGA 1 , P. AGOSTONI 2 , A. ABBATE 3 , M. VALGIMIGLI 4 , G. SANGIORGI 5 , G. TREVI 1

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PREDICTORS OF ADVERSE EVENTS IN PATIENTS WITH UNPROTECTED LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION

G. BIONDI-ZOCCAI1, C. MORETTI1, E. MELIGA1, P. AGOSTONI2,

A. ABBATE3, M. VALGIMIGLI4, G. SANGIORGI5, G. TREVI1

AND I. SHEIBAN1

1University of Turin, Turin, Italy ([email protected]); 2AZ Middelheim,

Antwerp, Belgium; 3Virginia Commonwealth University, Virginia, USA; 4University

of Ferrara, Ferrara, Italy; 5Emo Centro Cuore Columbus, Milano,Italy


Background
BACKGROUND LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION

  • Percutaneous drug-eluting stenting (DES) is being increasingly adopted as treatment for selected patients with unprotected left main coronary disease (ULM)

  • Evidence on predictors of adverse events, pivotal for such patient selection, is lacking to date


Objectives
OBJECTIVES LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION

  • To perform a systematic review of the outcomes of DES implantation in patients with ULM coronary disease

  • To pool major outcomes with meta-analytic techniques

  • To identify predictors of adverse events by means of meta-regression analysis


Methods
METHODS LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION

  • Several databases (BioMedCentral, clinicaltrials.gov, Google Scholar, and PubMed) were systematically searched for pertinent clinical studies published up to November 2006

  • Major selection criteria were:

    • enrolment of at least 20 patients

    • follow-up for at least 6 months

    • full text publication (thus excluding abstracts)


Methods1
METHODS LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION

  • Pre-specified subgroup analyses were performed according to ostial ULM, and non-high-risk features (defined by means of Parsonnet or EuroSCORE systems)

  • Generic-inverse-variance random-effect methods were used to pool incidence rates and adjusted risk estimates (95% confidence intervals)

  • Meta-regression was performed to identify regression coefficients (with 95% confidence intervals) for event predictors


Review profile
REVIEW PROFILE LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION


Results
RESULTS LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION

  • After excluding 806 non-pertinent citations, we finally included 16 original studies (1274 patients, median follow-up 9 months [range 6-24])

  • There were 8 uncontrolled reports on DES, 5 non-randomized comparison between DES and bare-metal stents (BMS), and 3 between DES and CABG

  • Overall, 31% of patients had non-bifurcational ULM and 59.5% had high-risk features at EuroSCORE or Parsonnet


Results1
RESULTS LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION

  • Mid-term MACE occurred in 18.2%, mid-term death in 4.4%, and repeat revascularization in 7.4%

  • Meta-regression showed that location of disease (ie non-bifurcational vs bifurcational ULM) was the most significant predictor of mid-term MACE (p=0.001) as well as of repeat revascularization (p=0.020)


Results2
RESULTS LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION

  • Intriguingly, disease location explained the vast majority of MACE risk across different patients and studies (R=-0.76, R2=0.58)

  • On the other hand, high-risk features at EuroSCORE or Parsonnet were the most significant predictor of mid-term death (p=0.027)


Risk of mace at follow up
RISK OF MACE AT FOLLOW-UP LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION


Meta regression
META-REGRESSION LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION


Meta regression1
META-REGRESSION LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION


Meta regression2
META-REGRESSION LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION


Conclusions
CONCLUSIONS LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION

  • Analysis of the largest cohort to date of patients treated with DES for ULM shows that risk-stratification should be based in these patients on location of disease and overall risk features

  • In particular, event-free survival is excellent in low-risk patients with non-bifurcational ULM, while a high case fatality can be expected in high-risk subjects, irrespective of disease location


For further slides on these topics please feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html


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