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Optimal reperfusion strategy in patients with acute STEMI and multivessel disease-an updated meta-analysis

G Fan1, Y W Zhang2, L Lin1

  • 1Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, 710004, Shaanxi, China.

Herz
|June 29, 2018
PubMed

Insights

Complete revascularization (CR) significantly reduces major adverse cardiac events, mortality, and myocardial infarction in acute ST-elevation myocardial infarction (STEMI) patients with multivessel disease compared to culprit-only revascularization (COR). CR is both safe and effective.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Acute ST-elevation myocardial infarction (STEMI) with multivessel disease presents complex treatment challenges.
  • Optimal reperfusion strategy remains a critical area of investigation for STEMI patients.
  • Comparing culprit-only revascularization (COR) versus complete revascularization (CR) is essential for patient outcomes.

Purpose of the Study:

  • To compare the efficacy and safety of COR and CR in STEMI patients with multivessel disease.
  • To determine the optimal reperfusion strategy for this patient population.

Main Methods:

  • Systematic meta-analysis of published multicenter randomized controlled trials.
  • Searched PubMed, Cochrane Library, and Ovid databases.
  • Analyzed data using Review Manager 5.3 software.

Main Results:

  • Eight trials involving 2870 patients (1604 COR, 1266 CR) were included.
  • CR significantly reduced major adverse cardiac events (MACE), mortality, myocardial infarction (MI), and repeat revascularization compared to COR.
  • No significant differences in safety outcomes (contrast-induced nephropathy, stroke, bleeding) were observed between CR and COR.

Conclusions:

  • Complete revascularization (CR) is an efficacious reperfusion strategy for STEMI patients with multivessel disease.
  • CR demonstrates a favorable safety profile, comparable to COR.
  • The findings support CR as the preferred strategy for optimal outcomes in this patient group.
Abstract

Keywords:
Culprit-only PCIMeta-analysisMultivessel diseasePercutaneous coronary interventionST-segment elevation myocardial infarction

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