Meta-Analysis of Multivessel Versus Culprit-Only Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome and Multivessel Coronary Disease

Even in the era of contemporary drug-eluting stents, it is not clear whether percutaneous coronary intervention (PCI) for nonculprit lesions can improve long-term outcomes in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) with multivessel coronary disease. Relevant studies...

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Published in:The American journal of cardiology 2015-04, Vol.115 (8), p.1027-1032
Main Authors: Jang, Jae-Sik, MD, PhD, Jin, Han-Young, MD, Seo, Jeong-Sook, MD, PhD, Yang, Tae-Hyun, MD, PhD, Kim, Dae-Kyeong, MD, PhD, Kim, Dong-Soo, MD, PhD, Cho, Kyoung-Im, MD, PhD, Kim, Bo-Hyun, MD, PhD, Park, Yong Hyun, MD, PhD, Je, Hyung-Gon, MD, PhD
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - physiopathology
Acute Coronary Syndrome - surgery
Acute coronary syndromes
Cardiovascular
Clinical outcomes
Coronary Artery Disease - physiopathology
Coronary Artery Disease - surgery
Electrocardiography
Heart attacks
Humans
Mortality
Percutaneous Coronary Intervention - methods
Studies
Treatment Outcome
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Summary:Even in the era of contemporary drug-eluting stents, it is not clear whether percutaneous coronary intervention (PCI) for nonculprit lesions can improve long-term outcomes in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) with multivessel coronary disease. Relevant studies published through August 2014 were searched and identified in the electronic databases. Summary estimates were obtained using a random-effects model. From 368 initial citations, 8 observational studies with 8,425 patients (3,227 multivessel and 5,198 culprit-only PCI) were included. Mean follow-up duration was 18 months. There were no significant differences in all-cause mortality (odds ratios [ORs] 0.85, 95% confidence interval [CI] 0.70 to 1.04) and myocardial infarction (OR 0.86, 95% CI 0.55 to 1.35). However, multivessel PCI was associated with a significantly lower rate of repeat revascularization (OR 0.75, 95% CI 0.56 to 1.00). Comparison of multivessel versus culprit-only PCI disclosed OR for major adverse cardiac events of 0.74 (95% CI 0.57 to 0.97). In conclusion, multivessel PCI reduced repeat revascularization without significant benefits in terms of mortality or myocardial infarction at the long-term follow-up in patients with NSTE-ACS and multivessel coronary disease. Future randomized studies that examine the safety and efficacy of multivessel PCI in NSTE-ACS are warranted.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2015.01.530