The clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis

Abstract

Background Optimal stent deployment is closely related to the prognosis of patients with coronary artery disease, but the effect of post-dilation on clinical and angiographic outcomes in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods PubMed, Embase, The Cochrane Library, Web of Science, CNKI and WANGFANG date-bases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with post-dilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes were comprised of all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, the angiographic outcomes were no reflow and slow reflow. Results A total of 11 studies enrolling 5663 patients met inclusion criteria. Our pooled analysis demonstrated that the post-dilation did not have significant impact on MACE (OR = 0.76, 95% CI 0.50–1.17; P = 0.21), stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P = 0.24), myocardial infarction (OR = 0.14, 95% CI 0.51–3.83; P = 0.51), and target vessel revascularization of clinical outcomes (OR = 0.61, 95% CI 0.21–1.80; P = 0.37) between post-dilation and non-post-dilation groups, but increased the risk of all-cause death (OR = 1.49, 95% CI 1.05–2.19; P = 0.03). There were no significant difference 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) of angiographic outcomes between two groups. Conclusions The post-dilation can increase the risk of all-cause death, without affecting the risks of MACE, stent thrombosis, myocardial infarction, target vessel revascularization, no reflow and slow reflow. However, more randomized controlled trials are required for investigating the benefits of post-dilation for patients with acute coronary syndrome (Registered by PROSPERO, CRD42020160748).