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Meta-Analysis of Optimal Revascularization Strategy for Patients With ST-Segment Elevation Myocardial Infarction and

Rahman Shah1, Mannu Nayyar2, Francis K Le1

  • 1Alabama College of Osteopathic Medicine, Dothan, Alabama; Gulf Coast Medical center, Panama City, Florida.

The American Journal of Cardiology
|June 17, 2020
PubMed

Insights

Complete revascularization (CR) significantly reduces cardiovascular mortality and myocardial infarction (MI) in ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease. CR should be the standard of care for these patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Complete revascularization (CR) is compared to infarct-related artery-only revascularization (IRA-OR) in ST-segment elevation myocardial infarction (STEMI) patients.
  • Previous trials suggest CR benefits, but lack power for hard outcomes like cardiovascular (CV) mortality.

Purpose of the Study:

  • To conduct an updated meta-analysis of contemporary studies comparing CR versus IRA-OR.
  • To determine the impact of CR on hard clinical outcomes in STEMI patients with multivessel coronary artery disease.

Main Methods:

  • Updated meta-analysis of 11 randomized controlled trials (RCTs).
  • Inclusion of 7,343 patients with STEMI and multivessel coronary artery disease.
  • Random effects model used for pooled risk ratio (RR) calculations.

Main Results:

  • CR was associated with significantly lower CV mortality (RR 0.75; P=0.04) compared to IRA-OR.
  • CR also showed reduced risk of myocardial infarction (MI) (RR 0.70) and recurrent revascularization (RR 0.38).
  • No significant difference in all-cause mortality was observed between CR and IRA-OR (RR 0.85).

Conclusions:

  • Complete revascularization (CR) is associated with improved outcomes in STEMI patients with multivessel coronary artery disease.
  • CR demonstrates reduced risk of CV mortality, MI, and repeat revascularization compared to IRA-OR.
  • CR should be considered the standard of care for STEMI patients with multivessel coronary artery disease.

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