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Impact of complete versus culprit-only revascularization on major adverse cardiovascular event in diverse
Huzaifa Ul Haq Ansari1, Farea Noman Dar2, Narmeen Shaikh3
1Department of Internal Medicine, Dow University of Health Sciences, Pakistan.
Insights
Complete percutaneous coronary intervention (PCI) significantly lowers major adverse cardiovascular events (MACE) risk in male, non-diabetic ST-elevation myocardial infarction patients under 65. This approach offers better outcomes than culprit-only PCI in specific patient groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Myocardial infarction (MI) management includes pharmaceuticals and percutaneous coronary intervention (PCI).
- Complete PCI has demonstrated noninferiority to culprit-only PCI.
- The impact of complete PCI on major adverse cardiovascular events (MACE) in various subpopulations remained unclear.
Purpose of the Study:
- To evaluate the effectiveness of complete PCI versus culprit-only PCI in ST-segment elevation myocardial infarction (STEMI) patients across different subpopulations.
- To identify specific patient groups that benefit most from complete PCI.
Main Methods:
- Systematic literature search of randomized controlled trials (RCTs) from January 2000 to May 2024.
- Inclusion of four RCTs involving STEMI patients.
- Data analysis using a random-effects model with inverse variance weighting.
Main Results:
- Complete PCI significantly reduced MACE risk in males compared to females (HR: 0.52; 95% CI: 0.39-0.68; p < 0.01).
- Complete PCI also lowered MACE risk in patients without diabetes.
- Patients under 65 years old showed reduced MACE risk with complete PCI compared to culprit-only PCI.
Conclusions:
- Complete PCI is associated with reduced MACE risk in male, non-diabetic STEMI patients under 65 with multivessel coronary artery disease.
- Findings suggest differential outcomes among subpopulations undergoing complete PCI.
- Further research is warranted to explore these subpopulation-specific outcome differences.
Abstract:
Background: Myocardial infarction management relies on pharmaceuticals and interventions like percutaneous coronary intervention (PCI). While complete PCI has shown noninferiority to culprit-only PCI, its impact on major adverse cardiovascular events (MACE) outcomes in multiple subpopulations has been unknown.Methods: A systematic literature search (from January 2000 to May 2024) identified four relevant randomized controlled trials involving ST-segment elevation myocardial infarction patients. Data analysis employed a random-effects model with inverse variance weighting.Results: MACE risk was significantly lower in males than females undergoing complete PCI compared with culprit-only PCI (hazard ratio: 0.52; 95% CI: 0.39-0.68; p < 0.01; I2 = 53%). Furthermore, complete PCI significantly lowered the risk of MACE outcomes in patients without diabetes and in patients under the 65-year age limit in comparison to culprit-only PCI.Conclusion: Complete PCI reduces MACE risk in male, nondiabetic ST-segment elevation myocardial infarction patients under 65 with multivessel coronary artery disease, necessitating further investigation into outcome differences among different subpopulations.
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