Related Experiment Video
Updated: Mar 18, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Complete vs Culprit-Only Percutaneous Coronary Intervention in STEMI With Multivessel Disease: A Meta-analysis and
Kevin R Bainey1, Robert C Welsh1, Bora Toklu2
1Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
Insights
Complete revascularization (CR) did not significantly reduce death or myocardial infarction (MI) in ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD). Further large trials are needed to confirm benefits, especially for hard clinical endpoints.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD) is often treated with culprit-only percutaneous coronary intervention (PCI).
- Complete revascularization (CR) has been proposed as a superior strategy, but evidence is based on composite outcomes with softer endpoints.
- This meta-analysis focuses on hard clinical endpoints to evaluate CR versus culprit-only PCI in STEMI patients.
Purpose of the Study:
- To compare the efficacy of routine complete revascularization (CR) versus culprit-only percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD).
- To emphasize the impact of these strategies on hard clinical endpoints, such as death and myocardial infarction (MI).
Main Methods:
- A meta-analysis of seven randomized trials involving 2004 patients (1065 CR, 939 culprit-only PCI) with STEMI and MVD undergoing primary PCI.
- The primary endpoint was long-term death or myocardial infarction (MI).
- Data were analyzed using a fixed-effects model, with trial sequential analysis performed for the overall population.
Main Results:
- Complete revascularization (CR) reduced the composite of death/MI (OR, 0.71; 95% CI, 0.52-0.96) but not death or recurrent MI individually.
- CR performed during index catheterization showed a reduction in death/MI (OR, 0.41; 95% CI, 0.25-0.65), death (OR, 0.59; 95% CI, 0.34-1.00), and recurrent MI (OR, 0.35; 95% CI, 0.18-0.69).
- Staged CR showed no significant benefits. Trial sequential analysis indicated insufficient evidence for CR reducing death/MI in the overall population.
Conclusions:
- Current evidence is insufficient to support routine complete revascularization (CR) for reducing death or myocardial infarction (MI) in ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD).
- The findings highlight the need for larger clinical trials powered for robust, hard clinical endpoints to definitively assess the role of CR.
Background:
Patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD) most commonly are treated with culprit-only percutaneous coronary intervention (PCI). However, this has been recently challenged, suggesting benefit with complete revascularization (CR). Still, these latest findings are largely based on clinical trials powered for composite outcomes that frequently include "softer" end points. We performed a meta-analysis comparing routine culprit-only PCI vs CR in STEMI, with an emphasis on "hard" clinical end points.
Methods:
MEDLINE, EMBASE, ISI Web of Science, and CENTRAL were searched from 1996-May 2015. Studies included patients with STEMI and MVD who received primary PCI. The primary end point was long-term death/myocardial infarction (MI). Data were combined using a fixed-effects model.
Results:
Seven randomized trials (2004 patients: 1065 CR and 939 culprit-only PCI procedures) were included. Compared with culprit-only PCI, CR reduced the composite of death/MI (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.52-0.96) but not death (OR, 0.78; 95% CI, 0.53-1.15) or recurrent MI (OR, 0.85; 95% CI, 0.58-1.24) alone. If CR was performed during the index catheterization, a reduction in death/MI was observed (death/MI: OR, 0.41; 95% CI, 0.25-0.65; death: OR, 0.59; 95% CI, 0.34-1.00; recurrent MI: OR, 0.35; 95% CI, 0.18-0.69). If staged, no benefits were noted (death/MI: OR, 0.99; 95% CI, 0.67-1.45; death: OR, 0.95; 95% CI, 0.56-1.61; recurrent MI: OR, 1.02; 95% CI, 0.61-1.70). However, when trial sequential analysis was performed for the overall population, the cumulative z-curve did not cross the monitoring boundary, suggesting a lack of evidence for reducing death/MI with CR (similar for index catheterization).
Conclusions:
In STEMI with MVD, there is insufficient evidence to support a reduction in death/MI with CR. Our results reinforce the need for larger clinical trials powered for robust clinical end points.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
14:24Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model
Published on: January 21, 2018
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Cardiac Catheterization I: Pre-Procedure Overview