Percutaneous Coronary Intervention versus Optimal Medical Therapy on Quality of Life and Functional Capacity Assessment in Chronic Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials
Notice bibliographique
Résumé
ABSTRACT Background Previous studies have primarily examined the impact of percutaneous coronary intervention (PCI) compared to optimal medical therapy (OMT) on hard outcomes such as all-cause mortality, cardiovascular death, nonfatal myocardial infarction, and the need for revascularization in patients with chronic coronary syndrome (CCS). However, these studies have not yielded significant findings thus far. Objective The goal of this meta-analysis was to assess the effect of PCI plus OMT on quality of life (QoL), functional capacity (FC), and angina-related health status compared to OMT alone in patients with CCS. Method Cochrane Central Registry of Controlled Trials, PubMed, Embase, and clininalTrials.gov were searched for studies published up to December 2023. The outcomes of interest were quality of life (QoL), freedom from angina (FFA), angina frequency (AF), and functional capacity (FC) measured with Seatle Angina Questionnaire (SAQ) or its equivalents such as EuroQol-5D (EQ-5D), 36-Item Short Form (SF-36) or RAND-36, and psychological well-being score if none is available. Additionally, the Duke Activity Status Index was also used to assess functional capacity when reported. Fixed-effect model was used for data analysis if I 2 statistics <50%; otherwise, the random-effect model was used. Sensitivity analysis was performed by using the leave-one-out meta-analysis which alternatively removes a trial from the study to assess its impact on the result as well as the interconversion between fixed-effects and random-effects models. A meta-regression analysis was also performed to evaluate the impact of covariates on QoL. Cochrane Risk of Bias Assessment Tool was used to assess the risk of bias. Results Seventeen randomized controlled trials that enrolled 13,588 patients satisfied our inclusion and exclusion criteria with an average age of 62.3±10 years. PCI plus OMT improved QoL with standardized mean difference (SMD) of 0.27 ([95% CI, 0.14-0.40]; P <0.001) and 0.21 ([95% CI, 0.12-0.30]; P <0.001) when compared to OMT alone at 6 months and 1 year respectively. PCI plus OMT was also associated with significant improvement in FFA (1.17 [95% CI, 1.11-1.24]; P < 0.001), AF (0.25 [95% CI, 0.20-0.30]; P <0.001), and FC (0.21 [95% CI, 0.12-0.31]; P <0.001) at 6 months and persisted at 3 years (QoL [0.18 [95% CI, 0.06-0.30]; P < 0.001], FFA [1.27 [95% CI, 1.11-1.45]; P < 0.001], AF [0.09 [95% CI, 0.02-0.16]; P = 0.009], FC [0.13 [95% CI, 0.02-0.23]; P = 0.02] respectively) . However, there appears to be a reduction in this effect with time. Meta-regression analysis using year of publication as covariate on QoL was performed. There was no statistically significant relationship between the year of publication and QoL at 1 year (P = 0.81). Conclusion In this meta-analysis, PCI combined with OMT was associated with better quality of life, greater freedom from angina, reduction in angina frequency, and improved functional capacity compared to OMT alone. These benefits persisted when followed longitudinally for 3 years. However, longer-term outcome data of these trials is needed to determine whether these improvements in quality of life are sustained or attenuated over time.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,022 | 0,040 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,026 | 0,054 |
| Bibliométrie | 0,005 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».