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Complete Versus Culprit-Only Revascularization for Patients With Multi-Vessel Disease Undergoing Primary Percutaneous

Islam Y Elgendy1, Xuerong Wen1, Ahmed Mahmoud1

  • 1Department of Medicine, University of Florida, Gainesville, Florida.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|November 4, 2015
PubMed

Insights

Complete revascularization during primary percutaneous coronary intervention (PCI) reduces major adverse cardiac events (MACE) and urgent revascularization. This strategy is safe, showing no increased risk of bleeding or kidney issues in STEMI patients with multi-vessel disease.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Conflicting evidence exists regarding optimal revascularization strategy during primary percutaneous coronary intervention (PCI).
  • Optimal management of multi-vessel disease in ST-elevation myocardial infarction (STEMI) remains debated.

Purpose of the Study:

  • To determine if complete revascularization of significant coronary lesions during primary PCI improves patient outcomes compared to culprit-only revascularization.
  • To update meta-analysis findings on revascularization strategies in STEMI patients.

Main Methods:

  • Meta-analysis of randomized clinical trials comparing complete versus culprit-only revascularization in STEMI patients with multi-vessel disease.
  • Utilized random effects models to calculate summary risk ratios (RR) for key outcomes.
  • Primary outcome assessed was the composite of mortality or myocardial infarction (MI).

Main Results:

  • Seven trials including 1,939 patients were analyzed.
  • Complete revascularization showed a non-significant trend towards reduced mortality or MI (RR 0.69, P=0.14).
  • Significant reduction in major adverse cardiac events (MACE) (RR 0.61, P<0.001) and urgent revascularization (RR 0.46, P<0.001) observed with complete revascularization.
  • No significant difference in major bleeding or contrast-induced nephropathy between strategies.

Conclusions:

  • Complete revascularization of all significant coronary lesions during primary PCI reduces MACE, primarily by decreasing urgent revascularization.
  • This approach is safe and does not increase the risk of major bleeding or contrast-induced nephropathy.
  • Complete revascularization is a favorable strategy for STEMI patients with multi-vessel disease.
Abstract

Keywords:
meta-analysismyocardial infarctionpercutaneous coronary intervention

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