Related Experiment Video
Updated: Apr 19, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Target-vessel versus multivessel revascularisation in ST-elevation myocardial infarction: a meta-analysis of
Kiran Sarathy1, Vinayak Nagaraja2, Amit Kapur1
1Prince of Wales Hospital, University of New South Wales, Sydney.
Insights
Treating non-infarct arteries during ST-elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI) may reduce adverse events. Multivessel PCI in STEMI patients showed lower rates of non-fatal MI and repeat revascularization compared to culprit-lesion-only PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Acute ST-segment elevation myocardial infarction (STEMI) management typically involves percutaneous coronary intervention (PCI) to address the infarct-related artery.
- The optimal strategy for treating significant stenoses in non-infarct related arteries during the same procedure remains controversial.
Purpose of the Study:
- To evaluate the clinical outcomes of multivessel revascularization compared to culprit-lesion-only revascularization in patients with acute STEMI.
Main Methods:
- A systematic literature search was performed across multiple databases (MEDLINE, PubMed, EMBASE, etc.).
- Data from four randomized trials involving 775 patients were analyzed to calculate pooled odds ratios (OR) and 95% confidence intervals (95% CI).
Main Results:
- Multivessel PCI was associated with significantly lower rates of non-fatal myocardial infarction (MI), refractory angina, and repeat revascularization.
- Composite endpoints including death, non-fatal MI, or refractory angina were also significantly reduced in the multivessel PCI group.
- Procedure length and contrast volume were comparable between the two strategies.
Conclusions:
- A strategy of treating significant non-infarct stenoses (preventive PCI) alongside the culprit lesion in acute STEMI patients undergoing primary PCI may improve cardiovascular outcomes.
- Further data are needed to fully validate these findings due to limitations in the current published literature.
Introduction:
In acute ST-segment elevation myocardial infarction (STEMI), coronary reperfusion with percutaneous coronary intervention (PCI) to treat the culprit lesion responsible for infarction improves clinical outcomes in nearly all patients. The concurrent treatment of non-infarct vessels with significant stenoses during initial angiography remains an area of controversy.
Methods:
A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane Library, Google Scholar, Science Direct, and Web of Science. Original data were abstracted from each study and used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI).
Results:
Only four randomised trials comprising 775 patients met full criteria for analysis. The incidence of non-fatal MI (3.25% vs 8.51%, OR: 0.376, 95% CI: 0.192-0.763), refractory angina (4.01% vs 9.57%, OR: 0.400, 95% CI: 0.241-0.741) and repeat revascularisation (10.52% vs 24.20%, OR: 0.336, 95% CI: 0.202-0.661) was lower in the multivessel revascularisation cohort. Death from cardiac causes or refractory angina or non-fatal MI (11.78% vs 28.86%, OR: 0.336, 95% CI: 0.223-0.505) and death from cardiac causes or non-fatal MI (5.26% vs 12.76%, OR: 0.420, 95% CI: 0.245-0.722) were significantly lower in the multivessel revascularisation cohort. The Median Contrast Volume and Procedure Length were similar in both cohorts.
Conclusions:
In patients with acute STEMI who undergo primary PCI, a strategy of treatment of significant non-infarct stenosis (preventive PCI) in addition to the culprit lesion responsible for infarction may result in improved cardiovascular outcomes and reduced overall mortality; however there is insufficient data to fully validate this from currently published literature.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care