Complete Revascularization in Patients With STEMI and Multi-Vessel Disease: A Meta-Analysis of Randomized Controlled Trials.
Cardiovasc Revasc Med
; 21(5): 684-691, 2020 05.
Article
in En
| MEDLINE
| ID: mdl-32241726
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); pâ¯=â¯0.0009; I2â¯=â¯72%], cardiovascular mortality [HR 0.74; 95% CI (0.56-0.99); pâ¯=â¯0.04; I2â¯=â¯2%], and repeat revascularization [HR 0.43; 95% CI (0.31-0.59); pâ¯<â¯0.00001; I2â¯=â¯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); pâ¯=â¯0.17; I2â¯=â¯49%], all-cause mortality [HR 0.86; 95% CI (0.65-1.13); pâ¯=â¯0.28; I2â¯=â¯14%], heart failure [HR 0.82 95% CI (0.51-1.32); pâ¯=â¯0.42; I2â¯=â¯26%], major bleeding [HR 1.07; 95% CI (0.66-1.75); pâ¯=â¯0.78; I2â¯=â¯25%], stroke [HR 0.67; 95% CI (0.24-1.89); pâ¯=â¯0.45; I2â¯=â¯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); pâ¯=â¯0.39; I2â¯=â¯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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Coronary Artery Disease
/
Percutaneous Coronary Intervention
/
ST Elevation Myocardial Infarction
Type of study:
Clinical_trials
/
Etiology_studies
/
Risk_factors_studies
/
Systematic_reviews
Limits:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Cardiovasc Revasc Med
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
Year:
2020
Document type:
Article