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Optimal Revascularization Strategy for Patients With ST-segment Elevation Myocardial Infarction and Multivessel

Kongyong Cui1,2,3,4, Dong Yin1,2,3,4, Chenggang Zhu1,2,3,4

  • 1Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Frontiers in Cardiovascular Medicine
|January 24, 2022
PubMed

Insights

Immediate or staged complete revascularization significantly reduces cardiovascular death or myocardial infarction (MI) compared to culprit-only percutaneous coronary intervention (PCI) in STEMI patients. Immediate revascularization shows the highest probability of being the best strategy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Optimal revascularization strategy for hemodynamically stable ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease is debated.
  • Comparing immediate complete revascularization, staged complete revascularization, and culprit-only percutaneous coronary intervention (PCI) is crucial for clinical decision-making.

Approach:

  • A systematic review and meta-analysis of randomized controlled trials was conducted.
  • Eleven trials involving 6,942 patients were analyzed using random-effects models for pairwise and network meta-analyses.
  • The primary endpoint was a composite of cardiovascular mortality or myocardial infarction (MI).

Key Points:

  • Both immediate and staged complete revascularization significantly reduced the risk of cardiovascular death or MI compared to culprit-only PCI.
  • Immediate complete revascularization was associated with a 52% risk reduction (RR 0.48, 95% CI 0.32-0.73).
  • Staged complete revascularization showed a 27% risk reduction (RR 0.73, 95% CI 0.61-0.88).

Conclusions:

  • Complete revascularization, whether immediate or staged, offers significant benefits over culprit-only PCI in STEMI patients with multivessel disease.
  • Immediate complete revascularization demonstrated the highest probability (77%) of being the optimal strategy.
  • Further research is needed to directly compare immediate versus staged complete revascularization strategies.

Keywords:
ST-segment elevation myocardial infarctionculprit-only percutaneous coronary interventionhard endpointsimmediate complete revascularizationstaged complete revascularization

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