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Published on: May 28, 2019
Metaanalysis of Multivessel vs Culprit Artery Only Percutaneous Coronary Intervention in ST Elevation Myocardial
Daniel C Garcia1, Alexandre M Benjo1, Christopher J White1,2
1Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA.
Insights
Multivessel percutaneous coronary intervention (PCI) significantly reduces mortality and reinfarction in ST-elevation myocardial infarction (STEMI) patients without cardiogenic shock compared to culprit artery only PCI. This strategy offers improved outcomes for STEMI treatment.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials and Meta-Analysis
Background:
- Primary percutaneous coronary intervention (PCI) is standard for ST-elevation myocardial infarction (STEMI).
- Current guidelines favor culprit artery only PCI.
- Emerging data suggest potential benefits of multivessel PCI in select STEMI patients.
Purpose of the Study:
- To evaluate the efficacy of multivessel PCI versus culprit artery only PCI in STEMI patients without cardiogenic shock.
- To assess the impact on mortality, reinfarction, and repeat revascularization.
Main Methods:
- Systematic search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials.
- Inclusion of four randomized clinical trials (1,044 patients) comparing multivessel PCI to culprit artery only PCI.
- Outcomes analyzed: all-cause mortality, cardiovascular mortality, reinfarction, and repeat revascularization.
Main Results:
- Multivessel PCI was performed in 566 patients; culprit artery only PCI in 478.
- Multivessel PCI significantly reduced all-cause mortality, cardiac death, reinfarction, and repeat revascularization (P < 0.05).
- This meta-analysis represents the largest randomized controlled trial evaluation of this comparison in STEMI without shock.
Conclusions:
- Multivessel PCI strategy is superior to culprit artery only PCI in STEMI patients without cardiogenic shock.
- The multivessel approach leads to significant reductions in mortality and reinfarction rates.
- Angiography alone was used for lesion severity grading in this analysis.
Abstract:
Background: Primary percutaneous coronary intervention (PCI) is the most frequently used treatment modality for patients presenting with ST elevation myocardial infarction (STEMI). Current professional society guidelines recommend culprit artery only PCI. Recent evidence suggests the potential benefit of multivessel PCI among patients with STEMI that is not complicated by cardiogenic shock. Methods: We systematically searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for clinical studies of patients with STEMI, not complicated by cardiogenic shock, who underwent primary PCI between January 1966 and January 2018. We evaluated all-cause and cardiovascular mortality, reinfarction, and repeat revascularization among patients randomized to a multivessel PCI strategy compared to a culprit artery only PCI strategy. Results: Four randomized clinical trials with a total of 1,044 patients met the inclusion criteria. Five hundred and sixty-six patients underwent multivessel PCI, and 478 patients underwent culprit artery only PCI. Multivessel PCI reduced all the studied endpoints: total death, cardiac death, reinfarction, and repeat revascularization (all P values <0.05). Conclusion: To our knowledge, this is the largest metaanalysis of randomized controlled trials studying multivessel PCI vs culprit artery only PCI in STEMI patients without shock, among whom lesion severity was graded by angiography alone. We found that compared to culprit artery only PCI, the multivessel PCI strategy was beneficial in reducing all-cause and cardiovascular mortality, reinfarction, and the need for repeat revascularization.
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