Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis

Abstract

Background: Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy. Methods: Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software. Results: A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I 2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I 2 = 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy. Conclusion: This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.

Surgical versus interventional coronary revascularization in kidney transplant recipients: a systematic review and meta-analysis

“…Our findings showed that PCI induced better outcomes than CABG in KTRs, regarding in-hospital, 1-year mortality and AKI prevalence rates. These findings are consistent with the previous investigations that demonstrated that PCI is more effective than CABG in reducing mortality rates among the different patient groups, including cardiomyopathy and heart transplant recipients with coronary allograft vasculopathy [ 13 , 14 ].…”

“…However, such evidence was obtained from a single investigation indicating the non-significant short and long-term difference between the two modalities. Moreover, Bagheri et al [ 14 ] showed that the 5-year survival outcomes favored PCI over CABG in cardiomyopathy patients. However, we did not find a significant difference at the last follow-up point, regarding all-cause mortality, which is also consistent with previous evidence [ 15 ].…”

Medical therapy versus percutaneous coronary intervention in ischemic heart disease: A cost-effectiveness analysis

“…Coronary angioplasty or PCI method that is used to open the closed arteries of the heart. In angioplasty, a small balloon is temporarily inserted into the closed area of the artery to help widen it ( 9 - 11 ).…”