Abstract 15579: Multivessel Coronary Artery Revascularization During Index Hospitalization Has Favorable Outcomes Compared to Infarct Related Artery Only Revascularization in STEMI Patients- Meta-Analysis of Randomized Control Trials

Abstract

Introduction: Multivessel coronary artery disease is present in about half of the patients presenting with STEMI. Timing of revascularization for the non-culprit vessels has been a long debate, with few trials suggesting benefit at index hospitalization rather than staging them at a later time. Current ACCF/AHA 2013 STEMI guidelines do not recommend PCI of non-infarct artery at the time of primary PCI but recommend it at a later time if patients are symptomatic. We hypothesized, complete revascularization during primary PCI or index hospitalization would have favorable outcomes compared to culprit vessel only revascularization. Aim: We performed meta-analysis of randomized control trials comparing multivessel vs. infarct artery only revascularization during primary PCI or index hospitalization. Methods and Results: Pubmed, Embace and Google scholar databases were searched for randomized control trials comparing multivessel vs. culprit vessel only revascularization during primary PCI or index hospitalization. We compared deaths, non-fatal MI and repeat revascularization events for the groups. Total number of patients in our study was 1819, with 919 patients in multivessel revascularization and 900 patients in infarct artery only revascularization groups. Mean follow up period was 28 months. Pooled analysis showed significant favorability for multivessel coronary revascularization comparing events of repeat revascularization (OR= 0.39, p<0.0001). There was also non-significant decrease in mortality (OR=0.92, p=0.7) and non-fatal MI (OR=0.68, p=0.09) with complete revascularization. Conclusions: In our study of STEMI patients, complete revascularization during primary PCI or index hospitalization has significantly decreased need for repeat revascularization and there was also non-significant decrease in mortality and non-fatal MI. Studies with larger sample size and longer follow up are needed for stronger evidence.