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Optimal percutaneous coronary intervention in patients with ST-elevation myocardial infarction and multivessel

An Vu Nguyen1, Le Van Thanh2, Mohamed Gomaa Kamel3

  • 1Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 70000, Viet Nam.

International Journal of Cardiology
|June 26, 2017
PubMed

Insights

Complete revascularization (CR) is superior to culprit-only revascularization (COR) for patients with MVD-STEMI, reducing major adverse cardiac events and repeat procedures. Immediate CR may offer a slight benefit over staged CR, though not statistically significant.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Percutaneous coronary intervention (PCI) strategies vary, including culprit-only (COR) and complete revascularization (CR).
  • CR can be performed immediately (ICR) or staged (SCR).
  • Optimal PCI strategy for MVD-STEMI patients remains under investigation.

Purpose of the Study:

  • To compare the efficacy and safety of COR versus CR (ICR and SCR) in MVD-STEMI patients.
  • To evaluate major adverse cardiac events (MACE), mortality, and repeat revascularization rates.
  • To assess differences between ICR and SCR when compared to COR.

Main Methods:

  • Systematic review and meta-analysis of 13 randomized controlled trials.
  • Inclusion criteria: comparison of at least two PCI strategies.
  • Adjusted analysis using person-years to pool rate ratios (RR) and 95% confidence intervals (CI).

Main Results:

  • COR significantly increased MACE (RR 1.67) and repeat revascularization (RR 2.12) compared to CR.
  • COR also increased MACE, cardiovascular mortality, MI, and repeat PCI for both ICR and SCR.
  • No significant differences were observed in all-cause mortality, MI, non-cardiovascular mortality, stroke, or bleeding.

Conclusions:

  • Complete revascularization (CR) is superior to culprit-only revascularization (COR) for MVD-STEMI patients regarding MACE and repeat revascularization.
  • CR demonstrates comparable safety outcomes to COR.
  • A trend towards reduced cardiovascular mortality and MI was noted for immediate CR (ICR) versus staged CR (SCR) when matched with COR, though not statistically significant.
Abstract

Keywords:
CulpritMeta-analysisPCIRevascularizationSystematic review

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