Author + information
- Received January 23, 2018
- Revision received February 16, 2018
- Accepted February 17, 2018
- Published online May 2, 2018.
- Vincenzo Pasceri, MD, PhDa,b,∗ (, )
- Giuseppe Patti, MDc,
- Francesco Pelliccia, MD, PhDb,
- Carlo Gaudio, MDb,
- Giulio Speciale, MDa,b,
- Roxana Mehran, MDd,e and
- George D. Dangas, MDd,e
- aSan Filippo Neri Hospital, Rome, Italy
- bLa Sapienza University, Rome, Italy
- cCampus Bio-Medico University, Rome, Italy
- dZena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- eCardiovascular Research Foundation, New York, New York
- ↵∗Address for correspondence:
Dr. Vincenzo Pasceri, Emodinamica, San Filippo Neri Hospital, Via G. Martinotti, 20, 00135 Rome, Italy.
Objectives The aim of this study was to compare complete revascularization with a culprit-only strategy in patients presenting with ST-segment elevation myocardial infarction (MI) and multivessel disease by a meta-analysis of randomized trials.
Background Although several trials have compared complete with culprit-only revascularization in ST-segment elevation MI, it remains unclear whether complete revascularization may lead to improvement in hard endpoints (death and MI).
Methods Randomized trials comparing complete revascularization with culprit-only revascularization in patients with ST-segment elevation MI without cardiogenic shock were identified by a systematic search of published research. Random-effects meta-analysis was performed, comparing clinical outcomes in the 2 groups.
Results Eleven trials were identified, including a total of 3,561 patients. Compared with a culprit-only strategy, complete revascularization significantly reduced risk for death or MI (relative risk [RR]: 0.76; 95% confidence interval [CI]: 0.58 to 0.99; p = 0.04). Meta-regression showed that performing complete revascularization at the time of primary percutaneous coronary intervention (PCI) was associated with better outcomes (p = 0.016). The 6 trials performing complete revascularization during primary PCI (immediate revascularization) were associated with a significant reduction in risk for both total mortality (RR: 0.62; 95% CI: 0.39 to 0.97; p = 0.03) and MI (RR: 0.40; 95% CI: 0.25 to 0.66; p < 0.001), whereas the 5 trials performing only staged revascularization did not show any significant benefit in either total mortality (RR: 1.02; 95% CI: 0.65 to 1.62; p = 0.87) or MI (RR: 1.04; 95% CI: 0.48 to 1.68; p = 0.86).
Conclusions When feasible, complete revascularization with PCI can significantly reduce the combined endpoint of death and MI. Complete revascularization performed during primary PCI was also associated with significant reductions in both total mortality and MI, whereas staged revascularization did not improve these outcomes.
- coronary interventions
- multivessel disease
- ST-segment elevation myocardial infarction
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 23, 2018.
- Revision received February 16, 2018.
- Accepted February 17, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.