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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Infarct related artery only versus complete revascularization in ST-segment elevation myocardial infarction and multi
Satyanarayana R Vaidya1, Santhosh R Devarapally2, Sameer Arora3
1Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, USA.
Insights
Complete revascularization in ST-segment elevation myocardial infarction (STEMI) patients significantly reduces major adverse cardiac events (MACE) and cardiovascular deaths compared to infarct artery (IRA) only intervention. This approach offers improved outcomes for STEMI patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials
Background:
- Current guidelines recommend only a weak indication for non-infarct artery intervention during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
- Emerging randomized controlled trials suggest substantial evidence supporting complete revascularization in STEMI patients.
Purpose of the Study:
- To compare the efficacy of complete revascularization versus infarct artery (IRA) only revascularization in patients with STEMI.
- To meta-analyze data from randomized controlled trials to assess outcomes associated with different revascularization strategies.
Main Methods:
- Systematic literature search of PUBMED, MEDLINE, EMBASE, and Cochrane central register for relevant randomized controlled trials.
- Meta-analysis of data from six trials involving 1,792 patients, with follow-up ranging from 6 months to 2.5 years.
- Calculation of summary risk ratios (RR) and 95% confidence intervals (CI) for key clinical outcomes.
Main Results:
- Complete revascularization significantly lowered the incidence of major adverse cardiac events (MACE) (13.8% vs. 25.1%) and repeat revascularization rates (8.2% vs. 18.9%).
- A significant reduction in cardiovascular mortality was observed in the complete revascularization group (2.0% vs. 4.6%).
- While non-fatal myocardial infarction and all-cause mortality rates were lower in the complete revascularization group, these differences were not statistically significant.
Conclusions:
- Complete revascularization in STEMI patients is associated with significantly lower rates of MACE and cardiovascular deaths compared to IRA-only revascularization.
- The study highlights the benefits of a comprehensive revascularization strategy for improving patient outcomes following STEMI.
Background:
The 2015 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) focused update on primary percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) only gives a class II b (weak) indication for non-infarct artery intervention at the time of primary PCI. Recent randomized controlled trials, however, suggest strong evidence supporting complete revascularization.
Methods:
A systematic search was conducted in PUBMED, MEDLINE, EMBASE and Cochrane central register for randomized controlled trials comparing complete versus infarct artery (IRA) only revascularization in patients with STEMI. A meta-analysis was performed using the data extracted from each study. Summary risk ratios (RR) and 95% confidence intervals (CI) were calculated for five outcomes.
Results:
Six trials fulfilled the inclusion criteria yielding 1,792 patients. Follow up ranged from 6 months to 2.5 years. The incidence of major adverse cardiac events (MACE) was significantly lower in the complete revascularization group compared to the IRA only revascularization (13.8% vs. 25.1%, RR =0.51; 95% CI: 0.41-0.64, P<0.00001). It was attributed to significantly lower repeat revascularization rate in the complete revascularization group (8.2% vs. 18.9%, RR =0.41; 95% CI: 0.31-0.54, P<0.00001). This meta-analysis also showed a significant reduction in cardiovascular mortality (2.0% vs. 4.6%, RR =0.42; 95% CI: 0.24-0.74; P=0.003), non-fatal myocardial infarction (4.37% vs. 5.76%, RR =0.64; 95% CI: 0.34-1.20; P=0.16) and all-cause mortality rates [(4.6% vs. 6%), RR =0.75; 95% CI: 0.49-1.14, P=0.17] in the complete revascularization group, compared to the IRA revascularization group.
Conclusions:
In patients who present with STEMI, complete revascularization is associated with lower rates of MACE and cardiovascular deaths as compared to revascularization of the IRA alone. Even though the outcomes of all-cause mortality and nonfatal re-infarction rates were lower in the complete revascularization group, they were not significant.
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