Multi-vessel versus culprit-vessel and staged percutaneous coronary intervention in STEMI patients with multivessel disease: a meta-analysis of randomized controlled trials

Abstract Introduction Percutaneous coronary intervention (PCI) is preferred in patients with acute ST-elevation myocardial infarction (STEMI). In patients with acute STEMI with multivessel disease (MVD), the guidelines recommend culprit vessel PCI (CV-PCI) in the absence of hemodynamic instability....

Full description

Saved in:
Bibliographic Details
Published in:Cardiovascular revascularization medicine 2014-11, Vol.15 (8), p.408-413
Main Authors: Dahal, Khagendra, Rijal, Jharendra, Panta, Raju, Lee, Juyong, Azrin, Michael, Lootens, Robert
Format: Article
Language:English
Subjects:
Angioplasty, Balloon, Coronary - methods
Cardiovascular
Coronary Artery Disease - surgery
Culprit vessel PCI
Electrocardiography - methods
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - blood
Male
Multi-vessel PCI
Multivessel disease
Myocardial Infarction - blood
Myocardial Infarction - mortality
Myocardial Infarction - surgery
Percutaneous Coronary Intervention - methods
Randomized Controlled Trials as Topic
STEMI
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Introduction Percutaneous coronary intervention (PCI) is preferred in patients with acute ST-elevation myocardial infarction (STEMI). In patients with acute STEMI with multivessel disease (MVD), the guidelines recommend culprit vessel PCI (CV-PCI) in the absence of hemodynamic instability. We performed a meta-analysis of all randomized controlled trials (RCTs) comparing multi-vessel PCI (MV-PCI) with CV-PCI or staged PCI (S-PCI) in patients with acute STEMI and MVD. Methods PubMed, EMBASE and CENTRAL were searched for publications since inception to December 2013. Random effects model was used to compute summary effects. Results Four RCTs (840 patients) were identified. MV-PCI compared to CV-PCI significantly reduced the risks of major adverse cardiac events (MACE)—a composite of MI, revascularization and all-cause mortality (RR: 0.46, 95% CI: 0.35–0.60, P < 0.00001) by reducing the risks of MI (0.35, 0.17–0.71, P = 0.004) and revascularization (0.35, 0.24–0.52, P < 0.00001). The risk of all-cause mortality was not different (0.69, 0.39–1.21, P = 0.19). S-PCI and MV-PCI had similar risks of MACE (0.96, 0.59–1.57, P = 0.87), MI (0.60, 0.20–1.78, P = 0.36), revascularization (0.86, 0.47–1.54, P = 0.60) and all-cause mortality (1.50, 0.44–5.07, P = 0.57). Conclusions MV-PCI compared to CV-PCI resulted in lower risks of MACE driven by lower MI and revascularization in patients with STEMI and multi-vessel disease.
ISSN:1553-8389
1878-0938
DOI:10.1016/j.carrev.2014.10.007