The Clinical and Angiographic Outcomes of Postdilation after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Abstract

Objective. The effect of postdilation in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of postdilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods. PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wangfang databases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with postdilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes comprised all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, and the angiographic outcomes were no reflow and slow reflow. Results. 11 studies met inclusion criteria. In clinical outcomes, our pooled analysis demonstrated that the postdilation had a tendency of decreasing MACE (OR = 0.67, 95% CI 0.45–1.00; $P$  = 0.05) but significantly increased all-cause death (OR = 1.49, 95% CI 1.05–2.12; $P$  = 0.03). No significant difference existed in stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; $P$  = 0.24), myocardial infarction (OR = 1.40, 95% CI 0.51–3.83; $P$  = 0.51), and target vessel revascularization (OR = 0.61, 95% CI 0.21–1.80; $P$  = 0.37) between postdilation and non-postdilation groups. In angiographic outcomes, there were no significant differences in no reflow (OR = 1.19, 95% CI 0.54–2.65; $P$  = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; $P$  = 0.24) between two groups. Conclusions. The postdilation tends to reduce the risk of MACE but significantly increases all-cause death, without significantly affecting stent thrombosis, myocardial infarction, target vessel revascularization, and coronary TIMI flow grade. However, more randomized controlled trials are required for investigating the effect of postdilation for patients with acute coronary syndrome (registered by PROSPERO, CRD42020160748).