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Culprit vessel versus immediate complete revascularization in patients with ST-segment myocardial infarction-a

Frederick A Spencer1, Nigar Sekercioglu2, Manya Prasad3

  • 1Department of Medicine, McMaster University, Hamilton, ON, Canada.

American Heart Journal
|December 19, 2015
PubMed

Insights

Performing multivessel percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease reduces repeat revascularization and nonfatal myocardial infarction (MI). This approach offers significant benefits without increasing mortality risk.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Trials & Meta-Analysis

Background:

  • Current guidelines recommend culprit-only percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease.
  • Emerging randomized controlled trials (RCTs) suggest potential benefits of performing PCI on non-culprit lesions concurrently.

Purpose of the Study:

  • To systematically review and meta-analyze RCTs comparing multivessel PCI versus culprit-only PCI in STEMI patients.
  • To evaluate the impact of multivessel PCI on key clinical outcomes including recurrent myocardial infarction (MI), revascularization, and mortality.

Main Methods:

  • A systematic review and meta-analysis of complete case data from eligible RCTs.
  • Data were sourced from multiple databases (MEDLINE, EMBASE, Cochrane, CINAHL) up to August 2015.
  • Random-effects models were used to pool risk ratios (RRs) and 95% confidence intervals (CIs) for primary outcomes.

Main Results:

  • Five RCTs comprising 1,606 patients were included, with 1,568 having complete data.
  • Multivessel PCI significantly reduced the risk of repeat revascularization (RR 0.36) and recurrent nonfatal MI (RR 0.58) over 2 years.
  • No significant increase in mortality (RR 0.82) or other adverse events was observed.

Conclusions:

  • Pooled data indicate moderate-certainty evidence for appreciable reduction in nonfatal MI with multivessel PCI.
  • High-certainty evidence supports a significant reduction in the need for repeat revascularization.
  • These benefits are likely to be highly valued by patients undergoing treatment for STEMI with multivessel disease.
Abstract

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