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Culprit vessel only versus multivessel percutaneous coronary intervention in patients presenting with ST-segment

Dongfeng Zhang1, Xiantao Song1, Shuzheng Lv1

  • 1Department of Cardiology, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China.

Plos One
|March 22, 2014
PubMed

Insights

For ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD), treating only the culprit artery during percutaneous coronary intervention (PCI) is linked to better outcomes than multivessel PCI (MV-PCI). This approach reduces mortality and renal dysfunction risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • Optimal treatment strategy for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) undergoing primary percutaneous coronary intervention (PCI) remains unclear.
  • Multivessel disease (MVD) is common in STEMI patients, necessitating careful consideration of intervention scope.

Purpose of the Study:

  • To compare the clinical outcomes of culprit vessel only percutaneous coronary intervention (culprit PCI) versus multivessel percutaneous coronary intervention (MV-PCI) in STEMI patients with MVD.
  • To provide evidence-based recommendations for PCI strategy in STEMI with MVD through a comprehensive meta-analysis.

Main Methods:

  • Systematic literature search of major databases (PubMed, Elsevier, Embase, CNKI) for relevant randomized and non-randomized studies.
  • Meta-analysis of included studies using Review Manager 5.1 to compare outcomes between culprit PCI and MV-PCI strategies.
  • Inclusion of data from 4 randomized and 14 non-randomized studies, encompassing 39,390 patients.

Main Results:

  • Multivessel PCI (MV-PCI) was associated with increased short-term and long-term mortality compared to culprit vessel only PCI (culprit PCI).
  • MV-PCI also showed a higher risk of renal dysfunction.
  • Conversely, MV-PCI demonstrated a reduced incidence of revascularization compared to culprit PCI.

Conclusions:

  • The findings support current guidelines recommending against treating non-culprit vessels during the index procedure for STEMI patients with MVD.
  • Culprit vessel only PCI appears to be a safer strategy regarding mortality and renal outcomes in this patient population.
Abstract

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