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Complete versus culprit-only revascularization in patients with multi-vessel disease undergoing primary percutaneous

Islam Y Elgendy1, Tianyao Huo1, Ahmed Mahmoud1

  • 1Department of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL, 32610, USA.

International Journal of Cardiology
|March 28, 2015
PubMed

Insights

Complete revascularization in ST-elevation myocardial infarction (STEMI) patients with multi-vessel disease significantly reduces major adverse cardiac events. This strategy, performed during primary percutaneous coronary intervention (PCI), lowers the need for urgent revascularization.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Optimal revascularization strategy for multi-vessel coronary disease in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains debated.
  • Current guidelines do not definitively favor complete over culprit-only revascularization in this high-risk population.

Purpose of the Study:

  • To evaluate the efficacy and safety of complete versus culprit-only revascularization strategies in STEMI patients with multi-vessel disease.
  • To determine the impact of complete revascularization on major adverse cardiac events and need for urgent revascularization.

Main Methods:

  • Systematic review and meta-analysis of randomized clinical trials comparing complete versus culprit-only revascularization in STEMI patients.
  • Searched Medline, Web of Science, Cochrane Register, and conference proceedings.
  • Random effects models were used to calculate summary risk ratios.

Main Results:

  • Six trials including 1,190 patients were analyzed, with a mean follow-up of 20.5 months.
  • Complete revascularization significantly reduced major adverse cardiac events (RR 0.57, p < 0.001), mainly due to a lower risk of urgent revascularization (RR 0.55, p = 0.01).
  • A trend towards reduced mortality or myocardial infarction was observed with complete revascularization, though not statistically significant (RR 0.56, p = 0.06).

Conclusions:

  • Complete revascularization of significant coronary lesions during primary PCI in STEMI patients with multi-vessel disease improves clinical outcomes.
  • The benefit is primarily driven by a reduction in the need for subsequent urgent revascularization procedures.
  • Larger prospective trials are warranted to confirm the impact on mortality and myocardial infarction reduction.
Abstract

Keywords:
Multivessel coronary artery diseaseMyocardial infarctionPrimary percutaneous coronary interventionRevascularization

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