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Multivessel Versus Culprit-Only Revascularization in STEMI and Multivessel Coronary Artery Disease: Meta-Analysis of
Varunsiri Atti1, Yeongjin Gwon2, Mahesh Anantha Narayanan3
1Department of Internal Medicine, Michigan State University, Lansing, Michigan.
Insights
Multivessel percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction patients with multivessel disease shows no difference in all-cause mortality but reduces reinfarction risk compared to culprit vessel-only PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Multivessel coronary artery disease (CAD) affects approximately 50% of ST-segment elevation myocardial infarction (STEMI) patients.
- Previous randomized trials comparing multivessel PCI to culprit vessel-only PCI have yielded conflicting outcomes regarding the benefits of a comprehensive revascularization strategy.
Purpose of the Study:
- To conduct a systematic review and meta-analysis of contemporary randomized controlled trials (RCTs).
- To evaluate the efficacy and safety of multivessel PCI versus culprit vessel-only PCI in STEMI patients with multivessel CAD.
Main Methods:
- A systematic literature search was performed across multiple databases and clinical trial registries up to September 15, 2019.
- A random-effects model meta-analysis was employed to synthesize data from 10 RCTs involving 7,030 patients.
- Primary outcomes included all-cause mortality and reinfarction; secondary outcomes assessed cardiovascular mortality, repeat revascularization, major bleeding, stroke, and contrast-induced nephropathy.
Main Results:
- Multivessel PCI did not significantly differ from culprit vessel-only PCI in terms of all-cause mortality (RR: 0.85; 95% CI: 0.68 to 1.05).
- Multivessel PCI was associated with a significantly lower risk of reinfarction (RR: 0.69; 95% CI: 0.50 to 0.95) and repeat revascularization (RR: 0.34; 95% CI: 0.25 to 0.44).
- There were no significant differences in major bleeding, stroke, or contrast-induced nephropathy between the two strategies.
Conclusions:
- In STEMI patients with multivessel CAD, multivessel PCI offers a significant reduction in reinfarction and repeat revascularization compared to culprit vessel-only PCI.
- The choice between multivessel PCI and culprit vessel-only PCI should consider the trade-off between reduced ischemic events and potential procedural risks.
Objectives:
The goal of this systematic review and meta-analysis was to provide a comprehensive evaluation of contemporary randomized trials addressing the efficacy and safety of multivessel versus culprit vessel-only percutaneous coronary intervention (PCI) among patients presenting with ST-segment elevation myocardial infarction and multivessel coronary artery disease.
Background:
Multivessel coronary artery disease is present in about one-half of patients with ST-segment elevation myocardial infarction. Randomized controlled trials comparing multivessel and culprit vessel-only PCI produced conflicting results regarding the benefits of a multivessel PCI strategy.
Methods:
A comprehensive search for published randomized controlled trials comparing multivessel PCI with culprit vessel-only PCI was conducted on ClinicalTrials.gov, PubMed, Web of Science, EBSCO Services, the Cochrane Central Register of Controlled Trials, Google Scholar, and scientific conference sessions from inception to September 15, 2019. A meta-analysis was performed using a random-effects model to calculate the risk ratio (RR) and 95% confidence interval (CI). Primary efficacy outcomes were all-cause mortality and reinfarction.
Results:
Ten randomized controlled trials were included, representing 7,030 patients: 3,426 underwent multivessel PCI and 3,604 received culprit vessel-only PCI. Compared with culprit vessel-only PCI, multivessel PCI was associated with no significant difference in all-cause mortality (RR: 0.85; 95% CI: 0.68 to 1.05) and lower risk for reinfarction (RR: 0.69; 95% CI: 0.50 to 0.95), cardiovascular mortality (RR: 0.71; 95% CI: 0.50 to 1.00), and repeat revascularization (RR: 0.34; 95% CI: 0.25 to 0.44). Major bleeding (RR: 0.92; 95% CI: 0.50 to 1.67), stroke (RR: 1.15; 95% CI: 0.65 to 2.01), and contrast-induced nephropathy (RR: 1.25; 95% CI: 0.80 to 1.95) were not significantly different between the 2 groups.
Conclusions:
Multivessel PCI was associated with a lower risk for reinfarction, without any difference in all-cause mortality, compared with culprit vessel-only PCI in patients with ST-segment elevation myocardial infarction.
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