Related Experiment Video

Updated: Jul 12, 2026

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
13:10

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

Published on: April 24, 2017

18.5K

Complete versus culprit-only coronary revascularization in patients with myocardial infarction and multivessel

Alfredo M Rodriguez-Granillo1,2, Walter Masson3, Martin Lobo4

  • 1Centro de Estudios en Cardiología Intervencionista (CECI), Buenos Aires, Argentina - Mrodriguezgranillo@gmail.com.

Panminerva Medica
|November 7, 2024
PubMed

Insights

Complete revascularization in ST-elevation myocardial infarction (STEMI) patients with multiple vessel disease (MVD) reduces non-fatal reinfarction and repeat revascularization. This strategy, using percutaneous coronary intervention (PCI), showed no difference in overall mortality compared to culprit-lesion-only PCI.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Current guidelines recommend complete revascularization (CR) for ST-elevation myocardial infarction (STEMI) patients with multiple vessel disease (MVD).
  • The FULL REVASC trial did not demonstrate a benefit of CR over culprit-lesion-only percutaneous coronary intervention (PCI) at 4.8 years.
  • An updated meta-analysis is needed to clarify the role of CR in reducing hard clinical endpoints.

Purpose of the Study:

  • To determine if complete revascularization (CR) is associated with decreased mortality and hard clinical endpoints compared to culprit-lesion-only PCI in STEMI patients with MVD.
  • To update existing meta-analyses with recent randomized clinical trial (RCT) data.
  • To evaluate the long-term clinical outcomes of different revascularization strategies.

Main Methods:

  • Systematic search of MEDLINE, Embase, Web of Science, and Cochrane Library databases (1990-2024).
  • Inclusion of RCTs comparing CR versus culprit-lesion-only PCI with follow-up ≥12 months, predominantly using drug-eluting stents.
  • Meta-analysis of cardiovascular endpoints, calculating odds ratios (ORs) for mortality, myocardial infarction (MI), and revascularization.

Main Results:

  • Eight RCTs with 9515 patients were included, with follow-up ranging from 12 months to 4.8 years.
  • Complete revascularization (CR) was associated with a reduced risk of myocardial infarction (MI) (OR: 1.38; 95% CI: 1.05-1.81) and ischemia-guided revascularization (OR: 2.81; 95% CI: 1.86-4.26) compared to culprit-lesion-only PCI.
  • No significant difference in overall mortality was observed between CR and culprit-lesion-only PCI (OR: 1.15; 95% CI: 0.98-1.36).

Conclusions:

  • In STEMI patients with MVD (without cardiogenic shock), complete revascularization (CR) via PCI significantly reduces the risk of non-fatal MI and ischemic-driven revascularization.
  • CR did not demonstrate a significant difference in overall mortality compared to culprit-lesion-only PCI.
  • These findings provide updated evidence on the benefits of CR in specific patient populations.
Abstract

More Related Videos

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels08:12

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

Published on: May 26, 2023

1.5K
Author Spotlight: Enhancing Coronary Artery Revascularization05:25

Author Spotlight: Enhancing Coronary Artery Revascularization

Published on: September 15, 2023

640

Related Concept Videos

Coronary Artery Disease IV: Preventive Measures01:26

Coronary Artery Disease IV: Preventive Measures

Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Angina IV: Management01:26

Angina IV: Management

IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...