Author + information
- Hector Garcia-Garcia1,
- Alexandre Hideo-Kajita2,
- Kayode Kuku2,
- Solomon Beyene2,
- Viana Azizi3,
- Yael Meirovich4,
- Gebremedhin Melaku5,
- Ahn Bui2,
- Aaphtaab Dheendsa2,
- Echo Brathwaite2,
- Sameer Desale2,
- Michael Lipinski2 and
- Ron Waksman2
- 1Medstar Washington Medical Center, Bethesda, Maryland, United States
- 2Medstar Washington Hospital Center, Washington, District of Columbia, United States
- 3Medstar Health Research Institute, Hyattsville, Maryland, United States
- 4MCRN, Washington, District of Columbia, United States
- 5Medstar Health Research Institute, Washington, Maryland, United States
The invasive strategy of treating the culprit vessel only (e.g. incomplete revascularization - IR) in patients with ST elevation myocardial infarction (STEMI) and multivessel disease (MVD) is a matter of debate. Current guidelines recommend that PCI should be restricted to the culprit vessel in these situations. However, newer data suggests that performing complete revascularization (CR) in MVD patients may lead to better outcomes compared to intervention in the culprit vessel only. The aim of this meta-analysis is to determine if CR following primary PCI in STEMI patients is associated with better outcomes.
Meta-analysis was performed by conducting a literature search of PubMed from January 2004 to May 2017. Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated under the random-effects model. The analysis compared the population of 9 studies (8 randomized controlled trials and 1 propensity-score matching study, total of 3.401 patients). CR was performed in 1.574 patients and IR in 1.827 patients.
The results for each endpoint are the following: major adverse cardiovascular events – MACE – (event rate: CR 14.6% vs. IR 25.0%, OR 0.47, 95% CI: 0.35-0.63, p<0.00001) (Figure 1); All-cause mortality (event rate: CR 4.12% vs. IR 5.5%, OR 0.67, 95% CI: 0.48-0.94, p=0.02); All-MI (event rate: CR 4.57% vs. IR 5.68%, OR 0.68, 95% CI: 0.44-1.05, p=0.08) and repeat revascularization (event rate: CR 8.37% vs. IR 18.38%, OR 0.37, 95% CI: 0.28-0.49, p<0.00001).
Compared to incomplete revascularization, complete revascularization is associated with reduction of all major cardiovascular outcomes. Revascularization guidelines may need to be updated in light of these new results.
CORONARY: Acute Myocardial Infarction