Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: Meta-analysis of randomised controlled trials

Mariusz Kowalewski, Volker Schulze, Sergio Berti, Ron Waksman, Jacek Kubica, Michalina Kołodziejczak, Antonino Buffon, Harry Suryapranata, Paul Alfred Gurbel, Malte Kelm, Wojciech Pawliszak, Lech Anisimowicz, Eliano Pio Navarese

Research output: Contribution to journalArticle

Abstract

Background: Current guidelines recommend culpritonly revascularisation (COR) in haemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) disease. Contrarily, growing body of evidence available from recent randomised controlled trials (RCTs) demonstrates improved outcomes with complete MV-percutaneous coronary intervention (PCI). Methods and results: We performed a meta-analysis of RCTs comparing complete MV-PCI with non-complete MV-PCI in STEMI and MV disease. Complete MV-PCI was defined as revascularisation to non-infarct-related artery lesions during index procedure, non-complete MVPCI-encompassed COR and staged approaches. Multiple databases and congress proceedings from major cardiovascular societies' meetings were screened for relevant studies. Primary endpoint was the composite of major adverse cardiac events (MACE) typically defined as death, recurrent myocardial infarction (MI) and repeat revascularisation. Secondary endpoints were cardiovascular mortality, recurrent MI and repeat revascularisation. Outcomes were analysed at longest available follow-up with differences accounted for with adjusted models by person-years. Seven RCTs (N=1303) were included. The median follow-up was 12 months. Complete MV-PCI reduced the odds of MACE compared with non-complete MV-PCI (OR (95% CIs) 0.59 (0.36 to 0.97), p=0.04) driven by reduction in recurrent MI (0.48 (0.27 to 0.85), p=0.01) and repeat revascularisation (0.51 (0.31 to 0.84), p=0.008). Complete MV-PCI was associated with a non-significant trend towards reduced cardiovascular mortality (0.54 (0.26 to 1.10), p=0.09) as well. In a sensitivity analysis, none of the baseline clinical variables significantly influenced overall estimates. Conclusions: In STEMI and MV disease, complete MVPCI as compared with non-complete strategy reduces MACE by 41%, driven by a 52% reduction in recurrent MI and 49% reduction in repeat revascularisation.

Original languageEnglish (US)
Pages (from-to)1309-1317
Number of pages9
JournalHeart
Volume101
Issue number16
DOIs
StatePublished - Aug 1 2015

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Percutaneous Coronary Intervention
Meta-Analysis
Randomized Controlled Trials
Myocardial Infarction
Mortality
ST Elevation Myocardial Infarction
Arteries
Databases
Guidelines

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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Kowalewski, M., Schulze, V., Berti, S., Waksman, R., Kubica, J., Kołodziejczak, M., ... Navarese, E. P. (2015). Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: Meta-analysis of randomised controlled trials. Heart, 101(16), 1309-1317. https://doi.org/10.1136/heartjnl-2014-307293

Complete revascularisation in ST-elevation myocardial infarction and multivessel disease : Meta-analysis of randomised controlled trials. / Kowalewski, Mariusz; Schulze, Volker; Berti, Sergio; Waksman, Ron; Kubica, Jacek; Kołodziejczak, Michalina; Buffon, Antonino; Suryapranata, Harry; Gurbel, Paul Alfred; Kelm, Malte; Pawliszak, Wojciech; Anisimowicz, Lech; Navarese, Eliano Pio.

In: Heart, Vol. 101, No. 16, 01.08.2015, p. 1309-1317.

Research output: Contribution to journalArticle

Kowalewski, M, Schulze, V, Berti, S, Waksman, R, Kubica, J, Kołodziejczak, M, Buffon, A, Suryapranata, H, Gurbel, PA, Kelm, M, Pawliszak, W, Anisimowicz, L & Navarese, EP 2015, 'Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: Meta-analysis of randomised controlled trials', Heart, vol. 101, no. 16, pp. 1309-1317. https://doi.org/10.1136/heartjnl-2014-307293
Kowalewski, Mariusz ; Schulze, Volker ; Berti, Sergio ; Waksman, Ron ; Kubica, Jacek ; Kołodziejczak, Michalina ; Buffon, Antonino ; Suryapranata, Harry ; Gurbel, Paul Alfred ; Kelm, Malte ; Pawliszak, Wojciech ; Anisimowicz, Lech ; Navarese, Eliano Pio. / Complete revascularisation in ST-elevation myocardial infarction and multivessel disease : Meta-analysis of randomised controlled trials. In: Heart. 2015 ; Vol. 101, No. 16. pp. 1309-1317.
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T1 - Complete revascularisation in ST-elevation myocardial infarction and multivessel disease

T2 - Meta-analysis of randomised controlled trials

AU - Kowalewski, Mariusz

AU - Schulze, Volker

AU - Berti, Sergio

AU - Waksman, Ron

AU - Kubica, Jacek

AU - Kołodziejczak, Michalina

AU - Buffon, Antonino

AU - Suryapranata, Harry

AU - Gurbel, Paul Alfred

AU - Kelm, Malte

AU - Pawliszak, Wojciech

AU - Anisimowicz, Lech

AU - Navarese, Eliano Pio

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background: Current guidelines recommend culpritonly revascularisation (COR) in haemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) disease. Contrarily, growing body of evidence available from recent randomised controlled trials (RCTs) demonstrates improved outcomes with complete MV-percutaneous coronary intervention (PCI). Methods and results: We performed a meta-analysis of RCTs comparing complete MV-PCI with non-complete MV-PCI in STEMI and MV disease. Complete MV-PCI was defined as revascularisation to non-infarct-related artery lesions during index procedure, non-complete MVPCI-encompassed COR and staged approaches. Multiple databases and congress proceedings from major cardiovascular societies' meetings were screened for relevant studies. Primary endpoint was the composite of major adverse cardiac events (MACE) typically defined as death, recurrent myocardial infarction (MI) and repeat revascularisation. Secondary endpoints were cardiovascular mortality, recurrent MI and repeat revascularisation. Outcomes were analysed at longest available follow-up with differences accounted for with adjusted models by person-years. Seven RCTs (N=1303) were included. The median follow-up was 12 months. Complete MV-PCI reduced the odds of MACE compared with non-complete MV-PCI (OR (95% CIs) 0.59 (0.36 to 0.97), p=0.04) driven by reduction in recurrent MI (0.48 (0.27 to 0.85), p=0.01) and repeat revascularisation (0.51 (0.31 to 0.84), p=0.008). Complete MV-PCI was associated with a non-significant trend towards reduced cardiovascular mortality (0.54 (0.26 to 1.10), p=0.09) as well. In a sensitivity analysis, none of the baseline clinical variables significantly influenced overall estimates. Conclusions: In STEMI and MV disease, complete MVPCI as compared with non-complete strategy reduces MACE by 41%, driven by a 52% reduction in recurrent MI and 49% reduction in repeat revascularisation.

AB - Background: Current guidelines recommend culpritonly revascularisation (COR) in haemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) disease. Contrarily, growing body of evidence available from recent randomised controlled trials (RCTs) demonstrates improved outcomes with complete MV-percutaneous coronary intervention (PCI). Methods and results: We performed a meta-analysis of RCTs comparing complete MV-PCI with non-complete MV-PCI in STEMI and MV disease. Complete MV-PCI was defined as revascularisation to non-infarct-related artery lesions during index procedure, non-complete MVPCI-encompassed COR and staged approaches. Multiple databases and congress proceedings from major cardiovascular societies' meetings were screened for relevant studies. Primary endpoint was the composite of major adverse cardiac events (MACE) typically defined as death, recurrent myocardial infarction (MI) and repeat revascularisation. Secondary endpoints were cardiovascular mortality, recurrent MI and repeat revascularisation. Outcomes were analysed at longest available follow-up with differences accounted for with adjusted models by person-years. Seven RCTs (N=1303) were included. The median follow-up was 12 months. Complete MV-PCI reduced the odds of MACE compared with non-complete MV-PCI (OR (95% CIs) 0.59 (0.36 to 0.97), p=0.04) driven by reduction in recurrent MI (0.48 (0.27 to 0.85), p=0.01) and repeat revascularisation (0.51 (0.31 to 0.84), p=0.008). Complete MV-PCI was associated with a non-significant trend towards reduced cardiovascular mortality (0.54 (0.26 to 1.10), p=0.09) as well. In a sensitivity analysis, none of the baseline clinical variables significantly influenced overall estimates. Conclusions: In STEMI and MV disease, complete MVPCI as compared with non-complete strategy reduces MACE by 41%, driven by a 52% reduction in recurrent MI and 49% reduction in repeat revascularisation.

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