Early versus delayed complete revascularisation in patients presenting with ST-segment elevation myocardial
Khaled Abouelmagd1, Hesham Tayel2, Ashraf Atta3
1Cardiology Department, Al-Azhar University, New Damietta, Egypt.
Insights
Complete revascularisation improves outcomes for ST-elevation myocardial infarction (STEMI) patients with multivessel disease. The timing of non-culprit lesion treatment, whether early or delayed, did not significantly impact major adverse cardiac events (MACE).
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Complete revascularisation is associated with improved clinical outcomes in ST-elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease.
- The optimal timing for revascularising non-culprit lesions in these patients remains a subject of debate.
Purpose of the Study:
- To conduct a systematic review and meta-analysis.
- To assess the impact of complete revascularisation timing on cardiovascular outcomes in STEMI patients with multivessel coronary artery disease.
Main Methods:
- Systematic literature search of PubMed, Cochrane Library, and ClinicalTrials.gov (2004-2019).
- Pairwise analysis comparing early (index procedure/hospitalisation) versus delayed (post-discharge) complete revascularisation.
- Primary endpoint: Major Adverse Cardiac Events (MACE), defined as all-cause mortality, recurrent myocardial infarction, unplanned revascularisation, or cardiovascular death.
Main Results:
- Twelve studies involving 7596 patients were analyzed.
- Early complete revascularisation showed a MACE rate of 10.37% vs. 18.17% for culprit-only PCI (p=0.01).
- Delayed complete revascularisation had a MACE rate of 11.81% vs. 17.21% for culprit-only PCI (p=0.01).
- Meta-regression revealed no significant relationship between the timing of complete revascularisation and MACE reduction (p=0.862).
Conclusions:
- Complete revascularisation offers a clinical benefit over culprit-only PCI in STEMI patients with multivessel disease, regardless of whether non-culprit lesions are treated early or delayed.
- The study did not demonstrate a significant association between the specific timing of complete revascularisation and the reduction of MACE.
Background:
Several studies have demonstrated that complete revascularisation improves clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease. However, the optimal timing of non-culprit lesion revascularisation remains controversial.
Objective:
The aim of this systematic review and meta-analysis was to assess the effect of timing of complete revascularisation on cardiovascular outcomes in patients with STEMI and multivessel coronary artery disease.
Methods:
Searches of PubMed, the Cochrane Library, ClinicalTrials.gov and the reference lists of relevant papers were conducted covering the period from 2004 to 2019. A pairwise analysis was performed to compare the difference in clinical outcome between early complete revascularisation (index procedure or index hospitalisation) and delayed complete revascularisation (after discharge) in patients with STEMI.The primary endpoint was the incidence of major adverse cardiac events (MACE), which was defined as the composite of all-cause mortality, recurrent myocardial infarction, unplanned repeated revascularisation and cardiovascular death.
Results:
Twelve studies including a total of 7596 patients were identified. The MACE rate was 10.37% in early complete revascularisation compared with 18.17% in culprit only (p=0.01). When complete revascularisation was delayed, the MACE rate was 11.81% after complete revascularisation compared with 17.21% in culprit-only percutaneous coronary intervention (PCI) (p=0.01). A meta-regression analysis demonstrated no relationship between timing of complete revascularisation and reduction in MACE relative to culprit-only PCI (p=0.862).
Conclusion:
In patients with STEMI treated by primary PCI and multivessel disease, there is a benefit of complete revascularisation over culprit-only PCI whether non-culprit revascularisation is performed early in hospital or delayed as an elective procedure. We have not demonstrated a relationship between timing of complete revascularisation and MACE.
Prospero Registration Number:
CRD42021226789.
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