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Complete Revascularization by Percutaneous Coronary Intervention for Patients With ST-Segment-Elevation Myocardial

Yousif Ahmad1,2, James P Howard2, Ahran Arnold2

  • 1Columbia University Medical Center/New York-Presbyterian Hospital New York NY.

Journal of the American Heart Association
|June 2, 2020
PubMed

Insights

Complete revascularization using percutaneous coronary intervention significantly reduces cardiovascular death and myocardial infarction in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease. This approach improves hard clinical outcomes compared to culprit-only revascularization.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Medicine

Background:

  • Optimal treatment for non-infarct-related arteries in ST-elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease remains debated.
  • Complete revascularization versus culprit-only revascularization is a critical consideration for these high-risk patients.

Purpose of the Study:

  • To evaluate the benefits of complete revascularization with percutaneous coronary intervention (PCI) versus culprit-only revascularization in STEMI patients with multivessel coronary artery disease.
  • To analyze individual clinical endpoints, including cardiovascular death and myocardial infarction.

Main Methods:

  • Systematic identification of randomized trials comparing complete revascularization (PCI) to culprit-only revascularization in STEMI patients with multivessel disease.
  • Random-effects meta-analysis of 10 studies including 7542 patients.
  • Primary efficacy endpoint: cardiovascular death (intention-to-treat); Secondary endpoints: all-cause mortality, myocardial infarction, unplanned revascularization.

Main Results:

  • Complete revascularization significantly reduced cardiovascular death (RR, 0.68; P=0.037) and myocardial infarction (RR, 0.65; P<0.0001).
  • Unplanned revascularization was also significantly reduced with complete revascularization (RR, 0.37; P<0.0001).
  • No statistically significant difference was observed in all-cause mortality (RR, 0.85; P=0.108).

Conclusions:

  • Complete revascularization with PCI in STEMI patients with multivessel disease significantly improves hard clinical outcomes, including cardiovascular death and myocardial infarction.
  • These findings support the consideration of complete revascularization in clinical practice guidelines for STEMI management.

Keywords:
ST‐segment–elevation myocardial infarctionpercutaneous coronary interventionrevascularization

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