Related Experiment Video

Updated: Apr 21, 2026

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

23.8K

Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and

Anil Pandit1, Madan Raj Aryal2, Aashrayata Aryal Pandit1

  • 1Division of Cardiovascular Diseases , Mayo Clinic , Scottsdale, Arizona , USA.

Open Heart
|October 22, 2014
PubMed

Insights

Preventive percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) significantly reduces cardiovascular deaths. This meta-analysis of randomized trials suggests broader PCI benefits beyond the culprit artery for STEMI patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Randomized trials suggest benefits of preventive percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI).
  • Existing trials are underpowered to definitively assess the impact on cardiac mortality.
  • A systematic review is needed to consolidate evidence on cardiac death reduction.

Purpose of the Study:

  • To systematically review randomized trial evidence on the cardiac mortality benefit of preventive PCI in acute STEMI patients.
  • To evaluate the impact of preventive PCI on cardiovascular outcomes in STEMI with multivessel disease.

Main Methods:

  • Systematic search of PubMed, Scopus, Cochrane, and clinicaltrials.gov databases up to September 2013.
  • Inclusion of randomized clinical trials only, with data abstraction by independent observers.
  • Meta-analysis using a fixed-effect model and heterogeneity assessment with I² statistics.

Main Results:

  • Three randomized trials involving 748 patients (416 preventive PCI, 332 culprit-only PCI) were analyzed.
  • Preventive PCI significantly lowered cardiovascular deaths (OR 0.39, 95% CI 0.18-0.83).
  • Reduced risks of repeat revascularization (OR 0.28) and non-fatal myocardial infarction (OR 0.38) were observed with preventive PCI.

Conclusions:

  • Preventive PCI in STEMI with multivessel disease is associated with reduced cardiovascular mortality compared to culprit-only PCI.
  • These findings suggest a mortality benefit that warrants confirmation.
  • Larger, adequately powered randomized clinical trials are recommended to validate these results.
Abstract

Keywords:
Coronary Artery Disease

More Related Videos

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction05:26

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction

Published on: May 28, 2019

11.1K
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

7.7K

Related Concept Videos

Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
1.9K
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
512
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
762
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
490
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
440
Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
641