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Physiology-Versus Angiography-Guided Complete Coronary Revascularization in STEMI Patients with Multivessel Disease:

Giovanni Martino1, Rossella Quarta2, Francesco Greco3

  • 1Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy.

Journal of Clinical Medicine
|January 25, 2025
PubMed

Insights

For ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD), angiography-guided complete revascularization (CR) offers better outcomes than physiology-guided CR. Angiography-guided CR significantly reduces major adverse cardiovascular events compared to culprit-only PCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials and Meta-Analysis

Background:

  • Patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) benefit from complete revascularization (CR) over culprit-only percutaneous coronary intervention (PCI).
  • The optimal CR strategy, whether guided by angiography or intracoronary physiology, remains an area of clinical uncertainty.

Purpose of the Study:

  • To compare the efficacy of angiography-guided CR, physiology-guided CR, and culprit-only PCI in patients with STEMI and MVD.
  • To evaluate the impact of different CR strategies on major adverse cardiovascular events (MACE), mortality, myocardial infarction, and revascularization.

Main Methods:

  • A network meta-analysis of 14 randomized controlled trials (RCTs) involving 11,568 patients.
  • Comparison of angio-guided CR, physiology-guided CR, and culprit-only PCI using frequentist and Bayesian approaches.
  • Assessment of outcomes including MACE, all-cause mortality, recurrent MI, cardiovascular death, and unplanned revascularization.

Main Results:

  • Angiography-guided CR significantly reduced MACE, recurrent MI, and unplanned revascularization compared to culprit-only PCI.
  • Physiology-guided CR also demonstrated reductions in MACE and unplanned revascularization.
  • While physiology-guided CR suggested a trend towards lower cardiovascular death, it did not reach statistical significance and was not superior to angio-guided CR in most outcomes.

Conclusions:

  • Angiography-guided CR appears to be the most effective strategy for patients with STEMI and MVD, yielding superior outcomes compared to physiology-guided CR.
  • Further large-scale randomized trials are warranted to definitively establish the relative benefits of angio-guided versus physiology-guided CR in this population.

Keywords:
STEMIcomplete revascularizationintermediate coronary artery lesionsmultivessel coronary diseasepercutaneous coronary interventionphysiology-guided PCI

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