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Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: meta-analysis of randomised

Mariusz Kowalewski1, Volker Schulze2, Sergio Berti3

  • 1Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Bydgoszcz, Poland Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany.

Heart (British Cardiac Society)
|June 4, 2015
PubMed

Insights

Complete revascularization in ST-segment elevation myocardial infarction (STEMI) with multivessel disease significantly reduces major adverse cardiac events. This strategy lowers recurrent myocardial infarction and repeat revascularization rates compared to culprit-only revascularization.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Current guidelines suggest culprit-only revascularization (COR) for stable STEMI patients with multivessel (MV) disease.
  • Emerging evidence from randomized controlled trials (RCTs) indicates better outcomes with complete MV-percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To compare the effectiveness of complete MV-PCI versus non-complete MV-PCI strategies in patients with STEMI and MV disease.
  • To evaluate the impact on major adverse cardiac events (MACE), cardiovascular mortality, recurrent myocardial infarction (MI), and repeat revascularization.

Main Methods:

  • A meta-analysis of seven RCTs involving 1303 patients was conducted.
  • Studies compared complete MV-PCI (revascularization of all significant MV lesions) with non-complete MV-PCI (COR or staged PCI).
  • Primary endpoint was MACE (death, recurrent MI, repeat revascularization); secondary endpoints included components of MACE.

Main Results:

  • Complete MV-PCI significantly reduced MACE compared to non-complete strategies (OR 0.59; p=0.04).
  • This reduction was driven by significantly lower rates of recurrent MI (OR 0.48; p=0.01) and repeat revascularization (OR 0.51; p=0.008).
  • A non-significant trend towards reduced cardiovascular mortality was observed with complete MV-PCI (OR 0.54; p=0.09).

Conclusions:

  • In STEMI patients with MV disease, complete MV-PCI is associated with a 41% reduction in MACE.
  • This benefit is primarily due to substantial reductions in recurrent MI (52%) and repeat revascularization (49%).
  • Complete MV-PCI represents a superior revascularization strategy in this patient population.
Abstract

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