Author + information
- Roisin Colleran1,
- Robert Byrne1,
- Himanshu Rai2,
- Felix Voll3,
- Daniele Giacoppo4,
- Salvatore Cassese1,
- Michael Joner3,
- Heribert Schunkert3 and
- Adnan Kastrati3
The optimal management of patients presenting with ST-segment elevation myocardial infarction (STEMI) with concomitant obstructive coronary artery lesions in addition to the culprit lesion is poorly defined. Prior meta-analyses have not comprehensively compared revascularization rates between treatment strategies. We performed an updated meta-analysis of randomized trials comparing complete versus culprit-only revascularization.
We searched Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), scientific session abstracts, and relevant websites for randomized trials investigating complete versus culprit-only revascularization in patients with STEMI published or posted between January 1, 2002 and April 30, 2017. The primary endpoint was all-cause death; secondary endpoints were revascularization at follow-up (excluding immediate or staged non-culprit lesion revascularization); cumulative revascularization (a composite of immediate or staged non-culprit revascularization and revascularization at follow-up); and myocardial infarction (MI). We derived odds ratios (OR) or incidence rate ratios (IRR) and calculated risk estimates for the main outcomes according to a random-effects model.
10 trials met the search criteria, randomizing 3,295 patients to complete (n=1,561) or culprit-only revascularization (n=1,734). All-cause death was similar for patients with complete and culprit-only revascularization (OR 0.81, 95% CI 0.57-1.15, p=0.31). Revascularization at follow-up was significantly lower in patients with complete revascularization (OR 0.39, 95% CI 0.32-0.49, p<0.01), however cumulative revascularization was significantly higher (IRR 3.98, 95% CI 3.52-4.49, p<0.01). Rates of MI were similar in both groups (OR 0.79, 95% CI 0.56-1.10, p=0.12).
In patients randomized to complete or culprit-only revascularization in STEMI, rates of death and MI at follow-up are similar. Although rates of revascularization at follow-up are lower in patients with complete revascularization, cumulative revascularization is higher compared with culprit-only revascularization. Cumulative revascularization rates should also be considered when deciding between treatment strategies in STEMI.
CORONARY: Acute Myocardial Infarction