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Meta-Analysis of Physiology-Guided Complete or Culprit Lesion-Only Percutaneous Coronary Interventions in Myocardial

Sahib Singh1, Udaya S Tantry2, Kevin Bliden2

  • 1Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland.

The American Journal of Cardiology
|September 19, 2024
PubMed

Insights

Physiology-guided complete revascularization significantly reduces cardiovascular death and repeat procedures in heart attack patients with multivessel disease compared to culprit-only PCI. This approach offers improved outcomes for myocardial infarction management.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Multivessel disease in myocardial infarction (MI) poses treatment challenges.
  • The optimal revascularization strategy, complete versus culprit-lesion-only percutaneous coronary intervention (PCI), remains debated.
  • Physiological guidance for complete revascularization is a key area of investigation.

Purpose of the Study:

  • To compare the efficacy and safety of physiology-guided complete revascularization versus culprit lesion-only PCI in patients with MI and multivessel disease.
  • To evaluate the impact of these strategies on mortality, repeat revascularization, and other adverse events.
  • To provide evidence-based recommendations for revascularization in complex coronary artery disease.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials.
  • Inclusion of studies comparing physiology-guided complete revascularization with culprit lesion-only PCI in MI patients.
  • Analysis of outcomes including all-cause death, cardiovascular death, repeat revascularization, MI, stent thrombosis, and contrast-associated nephropathy/acute kidney injury.

Main Results:

  • A total of 4,849 patients were included in the meta-analysis.
  • Physiology-guided complete revascularization was associated with significant reductions in cardiovascular death (OR 0.72, 95% CI 0.54-0.97, p=0.03) and repeat revascularizations (OR 0.50, 95% CI 0.38-0.66, p<0.00001).
  • No significant differences were observed in all-cause death, MI, stent thrombosis, or contrast-associated nephropathy/acute kidney injury between the two strategies.

Conclusions:

  • Physiology-guided complete revascularization is superior to culprit lesion-only PCI in reducing cardiovascular death and the need for repeat revascularization in patients with MI and multivessel disease.
  • This strategy offers a significant benefit for managing complex coronary artery disease.
  • Further research may explore long-term outcomes and cost-effectiveness.

Keywords:
FFRQFRculprit lesion-only PCIiFRmyocardial infarctionphysiology-guided complete PCI

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