A comparison of multivessel and culprit vessel percutaneous coronary intervention in non-ST-segment elevation acute coronary syndrome patients with multivessel disease: a meta-analysis.

Abstract

AIMS:

Percutaneous revascularisation triage has not been evaluated in randomised controlled trials of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel disease. As a result, current guidelines are not available. The objective of our meta-analysis was to investigate the use of percutaneous coronary intervention (PCI) in culprit and non-culprit vessels.

METHODS AND RESULTS:

We undertook a meta-analysis of controlled studies where patients were assigned to multivessel PCI or culprit vessel PCI. Summary odds ratios (OR) for all-cause mortality, myocardial infarction, unplanned revascularisation and major adverse cardiac events (MACE) were calculated using random- or fixed-effect models. Six registry studies (n=5,414) were included in this meta-analysis. There was no difference in the rate of mortality (OR, 0.85; 95% CI: 0.70 to 1.04; p=0.114) or myocardial infarction (OR, 0.75; 95% CI: 0.43 to 1.32; p=0.319) between the two treatment groups. Multivessel PCI may decrease long-term MACE (OR, 0.69; 95% CI: 0.51 to 0.93; p=0.015) and unplanned revascularisation (OR, 0.64; 95% CI: 0.45 to 93; p=0.018) compared with culprit vessel PCI.

CONCLUSIONS:

No significant difference was demonstrated in the long-term risk of myocardial infarction and mortality between multivessel PCI and culprit vessel PCI. Therefore, multivessel PCI may be a safe and reasonable option for NSTE-ACS patients with multivessel disease.

• Authors: Yan Qiao, Weiju Li, Salim Mohamed, Shaoping Nie, Xin Du, Yin Zhang, Changqi Jia, Xiao Wang, Xiaohui Liu, Changsheng Ma
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 11 Issue 5 Pg. 525-32 (Sep 2015) ISSN: 1969-6213 [Electronic] France
• PMID: 26390516 (Publication Type: Comparative Study, Journal Article, Meta-Analysis)

Topics

• Acute Coronary Syndrome (therapy)
• Humans
• Mortality
• Myocardial Infarction (epidemiology)
• Odds Ratio
• Percutaneous Coronary Intervention (methods)
• Treatment Outcome