Author + information
- Received April 6, 2020
- Revision received April 21, 2020
- Accepted April 22, 2020
- Published online July 6, 2020.
- Varunsiri Atti, MDa,
- Yeongjin Gwon, PhDb,
- Mahesh Anantha Narayanan, MDc,
- Santiago Garcia, MDd,
- Yader Sandoval, MDe,
- Emmanouil S. Brilakis, MD, PhDd,
- Mir B. Basir, DOf,
- Mohit K. Turagam, MDg,
- Akshay Khandelwal, MDf,
- Carlos Mena-Hurtado, MDc,
- Mamas A. Mamas, BM BChh,
- J. Dawn Abbott, MDi,
- Deepak L. Bhatt, MD, MPHj and
- Poonam Velagapudi, MD, MSb,∗ ()
- aDepartment of Internal Medicine, Michigan State University, Lansing, Michigan
- bDivision of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
- cDivision of Cardiology, Yale-New Haven Hospital, Hartford, Connecticut
- dDivision of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota
- eDivision of Cardiology, Mayo Clinic, Rochester, Minnesota
- fDivision of Cardiology, Henry Ford Hospital, Detroit, Michigan
- gDivision of Cardiology, The Icahn School of Medicine at Mount Sinai, New York, New York
- hDivision of Cardiology, Keele University, New Castle, United Kingdom
- iDivision of Cardiology, Brown University, Providence, Rhode Island
- jDivision of Cardiology, Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Poonam Velagapudi, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, Nebraska 68198-2265.
Objectives The goal of this systematic review and meta-analysis was to provide a comprehensive evaluation of contemporary randomized trials addressing the efficacy and safety of multivessel versus culprit vessel–only percutaneous coronary intervention (PCI) among patients presenting with ST-segment elevation myocardial infarction and multivessel coronary artery disease.
Background Multivessel coronary artery disease is present in about one-half of patients with ST-segment elevation myocardial infarction. Randomized controlled trials comparing multivessel and culprit vessel–only PCI produced conflicting results regarding the benefits of a multivessel PCI strategy.
Methods A comprehensive search for published randomized controlled trials comparing multivessel PCI with culprit vessel–only PCI was conducted on ClinicalTrials.gov, PubMed, Web of Science, EBSCO Services, the Cochrane Central Register of Controlled Trials, Google Scholar, and scientific conference sessions from inception to September 15, 2019. A meta-analysis was performed using a random-effects model to calculate the risk ratio (RR) and 95% confidence interval (CI). Primary efficacy outcomes were all-cause mortality and reinfarction.
Results Ten randomized controlled trials were included, representing 7,030 patients: 3,426 underwent multivessel PCI and 3,604 received culprit vessel–only PCI. Compared with culprit vessel–only PCI, multivessel PCI was associated with no significant difference in all-cause mortality (RR: 0.85; 95% CI: 0.68 to 1.05) and lower risk for reinfarction (RR: 0.69; 95% CI: 0.50 to 0.95), cardiovascular mortality (RR: 0.71; 95% CI: 0.50 to 1.00), and repeat revascularization (RR: 0.34; 95% CI: 0.25 to 0.44). Major bleeding (RR: 0.92; 95% CI: 0.50 to 1.67), stroke (RR: 1.15; 95% CI: 0.65 to 2.01), and contrast-induced nephropathy (RR: 1.25; 95% CI: 0.80 to 1.95) were not significantly different between the 2 groups.
Conclusions Multivessel PCI was associated with a lower risk for reinfarction, without any difference in all-cause mortality, compared with culprit vessel–only PCI in patients with ST-segment elevation myocardial infarction.
- cardiovascular mortality
- contrast-induced nephropathy
- culprit vessel–only revascularization
- major adverse cardiac events
- multivessel coronary artery disease
- multivessel revascularization
- repeat revascularization
- ST-segment elevation myocardial infarction
Dr. Garcia is a consultant for Abbott, Medtronic, Surmodics, and Osprey Medical; has received honoraria from Edwards Lifesciences, Medtronic, Abbott Vascular, and the American College of Cardiology; and has received grant support from Edwards Lifesciences and Boston Scientific. Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, the American Heart Association (associate editor, Circulation), Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (Board of Directors), Cardiovascular Systems, Elsevier, GE Healthcare, Infraredx, Medtronic, Siemens, and Teleflex; has received research support from Regeneron and Siemens; and is a shareholder in MHI Ventures. Dr. Basir has been a consultant for Abbott Vascular, Cardiovascular Systems, and Zoll; and has served as a consultant and received research grants for Abiomed and Chiesi. Dr. Mena-Hurtado is a consultant for Cook Medical, Medtronic, Cardinal Health, and Boston Scientific. Dr. Abbott has received research grants with no direct compensation from Abbott Vascular, Sinomed, AstraZeneca, Bristol-Myers Squibb, and Biosensors Research USA. Dr. Bhatt is an advisory board member for Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, and Regado Biosciences; is on the boards of directors of the Boston VA Research Institute, the Society of Cardiovascular Patient Care, and TobeSoft; is chair of the American Heart Association Quality Oversight Committee; is a member of data monitoring committees for the Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), the Cleveland Clinic (including for the ExCEED trial, funded by Edwards Lifesciences), the Duke Clinical Research Institute, the Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), and the Population Health Research Institute; has received honoraria from the American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org; vice chair, ACC Accreditation Committee), the Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee, funded by Boehringer Ingelheim; AEGIS-II executive committee, funded by CSL Behring), Belvoir Publications (editor-in-chief, Harvard Heart Letter), the Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (editor-in-chief, Journal of Invasive Cardiology), the Journal of the American College of Cardiology (guest editor, associate editor), Medtelligence/ReachMD (continuing medical education steering committees), the Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and U.S. national coleader, funded by Bayer), Slack Publications (chief medical editor, Cardiology Today’s Intervention), the Society of Cardiovascular Patient Care (secretary/treasurer), WebMD (continuing medical education steering committees); is deputy editor of Clinical Cardiology; is chair of the NCDR-ACTION Registry Steering Committee and the VA CART Research and Publications Committee; has received research funding from Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; has received royalties from Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); is a site co-investigator for Biotronik, Boston Scientific, Cardiovascular Systems, St. Jude Medical (now Abbott), and Svelte; is a trustee of the American College of Cardiology; and has conducted unfunded research for FlowCo, Merck, Novo Nordisk, PLx Pharma, and Takeda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received April 6, 2020.
- Revision received April 21, 2020.
- Accepted April 22, 2020.
- 2020 American College of Cardiology Foundation
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