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Staged versus One-Time Complete Revascularization with Percutaneous Coronary Intervention in STEMI Patients with
Zhenwei Li1, Yijiang Zhou2, Qingqing Xu3
1Department of Cardiology, The Affiliated Hospital Ningbo No.1 Hospital, Zhejiang University, Ningbo, PR China.
Insights
For ST-elevation myocardial infarction (STEMI) patients, staged percutaneous coronary intervention (PCI) significantly improves survival compared to one-time complete PCI. This approach should remain the standard for treating non-culprit vessels.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Percutaneous coronary intervention (PCI) is the preferred treatment for acute ST-elevation myocardial infarction (STEMI).
- The optimal strategy for managing multivessel disease (MVD) during primary PCI remains unclear, specifically comparing staged PCI (S-PCI) with one-time complete multivessel PCI (MV-PCI).
Purpose of the Study:
- To compare the efficacy and safety of staged PCI versus one-time complete PCI in patients with STEMI and MVD.
- To evaluate long-term outcomes, including major adverse cardiovascular events (MACE), mortality, reinfarction, and target-vessel revascularization.
Main Methods:
- A meta-analysis was conducted on randomized and non-randomized controlled trials identified through comprehensive database searches (PubMed, EMBASE, Cochrane).
- Studies included patients with STEMI and MVD undergoing primary PCI.
- Data were analyzed using a fixed-effects model to assess primary endpoints.
Main Results:
- The meta-analysis included 10 studies with 820 patients (562 S-PCI, 347 MV-PCI).
- Staged PCI significantly reduced both long-term (OR 0.44) and short-term mortality (OR 0.23) compared to MV-PCI.
- No significant differences were observed in reinfarction or target-vessel revascularization rates between the two strategies.
Conclusions:
- The staged PCI strategy for non-culprit lesions in STEMI patients demonstrates superior short- and long-term survival benefits.
- One-time complete MV-PCI may be associated with an increased risk of mortality.
- Further large-scale randomized trials are needed to definitively establish the optimal timing for staged procedures in STEMI management.
Introduction:
In patients with acute ST-elevation myocardial infarction (STEMI), the preferred intervention is percutaneous coronary intervention (PCI).Whether staged PCI (S-PCI) or one-time complete PCI (MV-PCI) is more beneficial and safer in terms of treating the non-culprit vessel during the primary PCI procedure is unclear. We performed a meta-analysis of all randomized and non-randomized controlled trials comparing S-PCI with MV-PCI in patients with acute STEMI and MVD.
Methods:
Studies of STEMI with multivessel disease receiving primary PCI were searched in PUBMED, EMBASE and The Cochrane Register of Controlled Trials from January 2004 to December 2014. The primary end points were long-term rates of major adverse cardiovascular events and their components-mortality, reinfarction, and target-vessel revascularization. Data were combined using a fixed-effects model.
Results:
Of 507 citations, 10 studies (4 randomized, 6 nonrandomized; 820 patients, 562 staged PCI and 347 one-time, complete multi-vessel PCI) were included. S-PCI compared to MV-PCI significantly reduced mortality both long-term (OR 0.44, 95% CI 0.29-0.66, P<0.0001, I2 = 0%) and short-term (OR 0.23, 95% CI 0.1-0.51, P = 0.0003, I2 = 0%). There was a trend toward reduced risk of MACE with s-PCI compared with MV-PCI (OR 0.83, 0.62-1.12, P = 0.22, I2 = 0%). No difference between S-PCI and MV-PCI was observed in reinfarction (OR 0.97, 0.61-1.55, P = 0.91, I2 = 0%), or target vessel revascularization (OR1.17, 95% CI 0.81-1.69, P = 0.40, I2 = 8%).
Conclusions:
The staged strategy for non-culprit lesions improved short- and long-term survival and should remain the standard approach to primary PCI in patients with STEMI; one-time complete multivessel PCI may be associated with greater mortality risk. However, additional large, randomized trials are required to confirm the optimal timing of a staged procedure on the non-culprit vessel in STEMI.
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