Staged versus One-Time Complete Revascularization with Percutaneous Coronary Intervention in STEMI Patients with Multivessel Disease: A Systematic Review and Meta-Analysis

In patients with acute ST-elevation myocardial infarction (STEMI), the preferred intervention is percutaneous coronary intervention (PCI).Whether staged PCI (S-PCI) or one-time complete PCI (MV-PCI) is more beneficial and safer in terms of treating the non-culprit vessel during the primary PCI proce...

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Bibliographic Details
Published in:PloS one 2017-01, Vol.12 (1), p.e0169406
Main Authors: Li, Zhenwei, Zhou, Yijiang, Xu, Qingqing, Chen, Xiaomin
Format: Article
Language:English
Subjects:
Aged
Angioplasty
Cardiovascular diseases
Care and treatment
Clinical trials
Electrocardiography
Female
Health aspects
Heart attacks
Humans
Intervention
Lesions
Male
Medicine and Health Sciences
Meta-analysis
Middle Aged
Mortality
Myocardial infarction
Myocardial revascularization
Patients
Percutaneous Coronary Intervention - methods
Physical Sciences
Randomization
Research and Analysis Methods
ST Elevation Myocardial Infarction - mortality
ST Elevation Myocardial Infarction - surgery
Stents
Systematic review
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Summary:In patients with acute ST-elevation myocardial infarction (STEMI), the preferred intervention is percutaneous coronary intervention (PCI).Whether staged PCI (S-PCI) or one-time complete PCI (MV-PCI) is more beneficial and safer in terms of treating the non-culprit vessel during the primary PCI procedure is unclear. We performed a meta-analysis of all randomized and non-randomized controlled trials comparing S-PCI with MV-PCI in patients with acute STEMI and MVD. Studies of STEMI with multivessel disease receiving primary PCI were searched in PUBMED, EMBASE and The Cochrane Register of Controlled Trials from January 2004 to December 2014. The primary end points were long-term rates of major adverse cardiovascular events and their components-mortality, reinfarction, and target-vessel revascularization. Data were combined using a fixed-effects model. Of 507 citations, 10 studies (4 randomized, 6 nonrandomized; 820 patients, 562 staged PCI and 347 one-time, complete multi-vessel PCI) were included. S-PCI compared to MV-PCI significantly reduced mortality both long-term (OR 0.44, 95% CI 0.29-0.66, P
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0169406