Author + information
- Alexandre Hideo-Kajita1,
- Hector Garcia-Garcia2,
- Kayode Kuku1,
- Solomon Beyene1,
- Viana Azizi1,
- Yael Meirovich3,
- Gebremedhin Melaku4,
- Ahn Bui1,
- Aaphtaab Dheendsa1,
- Echo Brathwaite1,
- Sameer Desale1,
- Michael Lipinski1 and
- Ron Waksman1
- 1Medstar Washington Hospital Center, Washington, District of Columbia, United States
- 2Medstar Washington Medical Center, Bethesda, Maryland, United States; Health Research Institute, Hyattsville, Maryland, United States
- 3MCRN, Washington, District of Columbia, United States
- 4Medstar Health Research Institute, Washington, Maryland, United States
Current guidelines for percutaneous revascularization in patients with ST elevation myocardial infarction (STEMI) and multivessel disease (MVD) advise restricting intervention to the culprit vessel at the index procedure. However, recent data, suggests that complete revascularization (CR) is associated with improvement of outcomes in MVD patients. Thus, complete revascularization strategy can be performed at the index procedure (e.g. index complete revascularization – ICR) or staged in a second procedure within a specific time (e.g. staged complete revascularization – SCR). The aim of this meta-analysis is to determine if there is any significant difference between ICR and SCR.
A literature search of PubMed was performed to identify studies published from January 2004 to May 2017. Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with 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), of whom 1.574 patients were treated with CR. A total of 646 patients underwent ICR and 928 patients in the SCR group.
The major adverse cardiovascular events (MACE) incidence rate was 10.8% (OR 0.33, 95% CI: 0.24-0.45, p<0.00001) in the ICR group compared to 17.2% (OR 0.58, 95% CI: 0.40-0.84, p<0.004) in the SCR group (Figure 1); all-cause mortality in the ICR group was 3.5% (OR 0.69, 95% CI: 0.41-1.19, p=0.18) and 4.5% (OR 0.66, 95% CI: 0.36-1.22, p=0.19)in the SCR group ; the incidence of All-MI was 2.6% (OR 0.39, 95% CI: 0.22-0.68, p=0.0010) in the ICR group and 5.9.% in the SCR group (OR 0.95, 95% CI: 0.56-1.61, p=0.86); the incidence of repeat revascularization was 7.5% (OR 0.29, 95% CI: 0.21-0.41, p<0.00001) in the ICR group compared to 9.0% (OR 0.45, 95% CI: 0.29-0.72, p=0.0007) in the SCR group.
Compared to staged PCI, achieving complete revascularization at index procedure demonstrated reductions in MACE, all-MI and repeat revascularization.
CORONARY: Acute Myocardial Infarction