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Published on: May 28, 2019
Culprit-lesion only versus complete multivessel percutaneous intervention in ST-elevation myocardial infarction: A
Pedro A Villablanca1, David F Briceno1, Daniele Massera1
1Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA.
Insights
Multivessel (MV) percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (CAD) significantly reduces major adverse cardiovascular events (MACE), cardiovascular mortality, and repeat revascularization compared to culprit-lesion only (CLO) PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- ST-segment elevation myocardial infarction (STEMI) with multivessel (MV) coronary artery disease (CAD) is linked to adverse outcomes.
- The optimal revascularization strategy, culprit-lesion only (CLO) PCI versus MV PCI, remains uncertain in STEMI patients with MV CAD.
Purpose of the Study:
- To conduct an updated meta-analysis comparing the efficacy and safety of MV PCI versus CLO PCI in STEMI patients with MV CAD.
Main Methods:
- A systematic literature search was performed across major databases including PubMed, CENTRAL, EMBASE, and ClinicalTrials.gov.
- Included studies were randomized controlled trials (RCTs) evaluating MV PCI versus CLO PCI in STEMI patients.
Main Results:
- Seven RCTs comprising 2006 patients were analyzed.
- MV PCI demonstrated a significant reduction in major adverse cardiovascular events (MACE) (OR, 0.62), cardiovascular mortality (OR, 0.46), and repeat revascularization (RRV) (OR, 0.39) compared to CLO PCI.
- No significant differences were observed in subsequent myocardial infarction, all-cause mortality, bleeding events, contrast-induced nephropathy, or stroke between the two approaches.
Conclusions:
- MV PCI significantly lowers the rates of MACE, cardiovascular mortality, and RRV in STEMI patients with MV CAD.
- The MV PCI strategy offers significant clinical benefits without a notable increase in harm compared to CLO PCI.
Background:
ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel (MV) coronary artery disease (CAD) is associated with poor outcomes. Percutaneous coronary intervention (PCI) of the culprit-lesion only (CLO) as compared with a MV PCI approach to revascularization remains uncertain. Our objective is to gain a better understanding of the efficacy and safety of CLO as compared with MV PCI in patients with STEMI by conducting an updated meta-analysis.
Methods:
A comprehensive search of PubMed, CENTRAL, EMBASE, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar databases of randomized controlled trials (RCTs) was performed.
Results:
Seven RCTs were included, enrolling a total of 2006 patients. We found that there was a significant reduction in major adverse cardiovascular events (MACE) (OR, 0.62; 95% CI, 0.43-0.90), cardiovascular mortality (OR, 0.46; 95% CI, 0.27-0.80), and repeat revascularization (RRV) (OR, 0.39; 95% CI, 0.30-0.51) favoring MV over the CLO approach for patients undergoing primary PCI. The number needed to treat in order to prevent one CV mortality, RRV, or MACE event is 47, 11, and 16 patients, respectively. No differences were observed between MV vs. CLO PCI for subsequent myocardial infarction (OR, 0.74; 95% CI, 0.40-1.39), all-cause mortality (OR, 0.78; 95% CI, 0.53-1.15), non-cardiovascular mortality (OR, 1.35; 95% CI, 0.74-2.48), all-bleeding events (OR, 0.82; 95% CI, 0.40-1.65), contrast-induced nephropathy (OR, 0.72; 95% CI, 0.33-1.54), and stroke (OR, 1.28; 95% CI, 0.47-3.46).
Conclusions:
MV PCI significantly reduces the rate of MACE, CV mortality, and RRV without significant harm as compared to CLO PCI.
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