Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled trials.

Abstract

AIMS:

To perform a pairwise meta-analysis of randomized controlled trials (RCTs) comparing multivessel percutaneous coronary intervention (PCI) and culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI) patients without cardiogenic shock.

METHODS:

We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for RCTs comparing multivessel PCI with culprit vessel-only PCI in STEMI patients without cardiogenic shock and multivessel coronary artery disease. Only RCTs reporting mortality or myocardial reinfarction after at least 6 months following randomization were included. Hazard ratios (HRs) were pooled using random-effect models.

RESULTS:

Nine RCTs were included in the final analysis. In total, 523 (8.3%) of 6314 patients suffered the combined primary endpoint of death or non-fatal reinfarction. This primary endpoint was significantly reduced with multivessel PCI compared to culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43-0.93; p = 0.03). This finding was driven by a reduction of non-fatal reinfarction (HR 0.64, 95% CI 0.52-0.79; p = 0.001), whereas no significant reduction of all-cause death (HR 0.77, 95% CI 0.44-1.35; p = 0.28) or cardiovascular death (HR 0.64, 95% CI 0.37-1.11; p = 0.09) was observed.

CONCLUSIONS:

In STEMI patients without cardiogenic shock multivessel PCI reduced the risk of death or non-fatal reinfarction compared to culprit vessel-only PCI.

• Authors: Hans-Josef Feistritzer, Alexander Jobs, Suzanne de Waha-Thiele, Ingo Eitel, Anne Freund, Mohamed Abdel-Wahab, Steffen Desch, Holger Thiele
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 109 Issue 11 Pg. 1381-1391 (Nov 2020) ISSN: 1861-0692 [Electronic] Germany
• PMID: 32239284 (Publication Type: Journal Article, Meta-Analysis, Review)

Topics

• Coronary Angiography (methods)
• Coronary Vessels (diagnostic imaging, surgery)
• Humans
• Percutaneous Coronary Intervention (methods)
• Randomized Controlled Trials as Topic
• ST Elevation Myocardial Infarction (diagnosis, surgery)