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The optimal percutaneous coronary intervention strategy for patients with ST-segment elevation myocardial infarction

Meng-Jin Hu1, Jiang-Shan Tan1, Wen-Yang Jiang1

  • 1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Therapeutic Advances in Chronic Disease
|March 17, 2022
PubMed

Insights

For ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease, immediate or staged multivessel PCI reduces long-term MACE. Staged PCI appears superior to immediate PCI for reducing long-term all-cause death.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease presents complex treatment challenges.
  • Optimal percutaneous coronary intervention (PCI) strategy remains a subject of investigation to improve patient outcomes.

Purpose of the Study:

  • To determine the optimal PCI strategy for patients diagnosed with STEMI and multivessel coronary artery disease.
  • To compare immediate multivessel PCI, staged multivessel PCI, and culprit-only PCI.

Main Methods:

  • A meta-analysis combining data from 13 randomized trials (7627 patients) and 21 prospective observational studies (60311 patients).
  • Random effect risk ratios (RR) and 95% confidence intervals (CI) were calculated to assess outcomes.
  • Analysis focused on major adverse cardiac events (MACE), myocardial infarction, revascularization, and all-cause death.

Main Results:

  • Randomized trials indicated that immediate or staged multivessel PCI lowered long-term MACE compared to culprit-only PCI.
  • Multivessel PCI strategies reduced risks of myocardial infarction and revascularization but showed no significant difference in all-cause death in randomized trials.
  • Observational studies suggested staged multivessel PCI reduced long-term all-cause death, while immediate multivessel PCI increased short-term all-cause death.

Conclusions:

  • Multivessel PCI, whether immediate or staged, is preferable for STEMI patients with multivessel disease based on long-term outcome improvements in randomized trials.
  • Real-world data from observational studies suggest staged multivessel PCI may be superior to immediate multivessel PCI.
  • Staged multivessel PCI is proposed as the optimal strategy for this patient population.
Abstract

Keywords:
ST-segment elevation myocardial infarctionmultivessel diseasemultivessel revascularizationnetwork meta-analysispercutaneous coronary intervention

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