Complete Revascularization in Patients With STEMI and Multi-Vessel Disease: A Meta-Analysis of Randomized Controlled Trials

Ahmad Al-Abdouh, Mahmoud Barbarawi, Anas Bizanti, Ibrahim Abudaya, Sireesha Upadhrasta, Hadi Elias, Di Zhao, Nazir Savji, Harini Lakshman, Rani Hasan, Erin D. Michos

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Percutaneous coronary intervention (PCI) is the treatment of choice for ST-elevation myocardial infarction (STEMI). However, efficacy of complete vs culprit only revascularization in patients with STEMI and multivessel disease remains unclear. Methods: We searched PubMed/MEDLINE, and Cochrane library. The primary endpoint was major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), repeat revascularization, stroke, major bleeding, and contrast induced nephropathy. Estimates were calculated as random effects hazard ratios (HRs) with 95% confidence intervals (CI). Results: Twelve trials with 7592 patients were included. There was a significantly lower risk of MACE [HR 0.61; 95% CI (0.43–0.60); p = 0.0009; I2 = 72%], cardiovascular mortality [HR 0.74; 95% CI (0.56–0.99); p = 0.04; I2 = 2%], and repeat revascularization [HR 0.43; 95% CI (0.31–0.59); p < 0.00001; I2 = 67%] in patients treated with complete compared with culprit-only revascularization. There was no statistically significant difference in MI [HR 0.77; 95% CI (0.52–1.12); p = 0.17; I2 = 49%], all-cause mortality [HR 0.86; 95% CI (0.65–1.13); p = 0.28; I2 = 14%], heart failure [HR 0.82 95% CI (0.51–1.32); p = 0.42; I2 = 26%], major bleeding [HR 1.07; 95% CI (0.66–1.75); p = 0.78; I2 = 25%], stroke [HR 0.67; 95% CI (0.24–1.89); p = 0.45; I2 = 54%], or contrast induced nephropathy, although higher contrast volumes were used in the complete revascularization group [HR 1.22; 95% CI (0.78–1.92); p = 0.39; I2 = 0%]. Conclusion: Complete revascularization was associated with a significantly lower risk of MACE, cardiovascular mortality, and repeat revascularization compared with culprit-only revascularization. These results suggest complete revascularization with PCI following STEMI and multivessel disease should be considered.

Original languageEnglish (US)
Pages (from-to)684-691
Number of pages8
JournalCardiovascular Revascularization Medicine
Volume21
Issue number5
DOIs
StatePublished - May 2020

Keywords

  • And STEMI
  • Complete
  • Culprit
  • Revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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