Abstract
Introduction: ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel coronary artery disease (CAD) is associated with poor prognosis. Hypothesis: We sought to determine the merits of percutaneous coronary intervention (PCI) of the culprit-only compared with a complete revascularization approach. Methods: The MEDLINE (PubMed, Ovid), Embase, Clinicaltrials.org and Cochrane databases were queried with various combinations of medical subject headings (MeSH) to identify articles comparing complete and culprit-only revascularization. Data were compared using a random-effect model to calculate unadjusted odds ratio. Results: A total of 26 studies consisting of 26,892 patients, 18,377 in the culprit-only and 8,515 in the complete revascularization group were included. The mean age of patients included in the study was 63 years, comprising 72% of male patients. Baseline characteristics of the two treatment groups were comparable. On a median follow-up of 1-year, culprit-only revascularization was associated with a significantly higher odds of major adverse cardiovascular events (MACE) (OR 1.36, 95% CI 1.10-1.69, p=0.005) (figure), angina (OR 2.28, 95% CI 1.83-2.85, p=<0.00001) and revascularization (OR 1.71, 95% CI 1.18- 2.49, p=0.005) compared to complete revascularization group. The all-cause mortality (OR 1.17, 95% CI 0.89-1.54, p=0.25),, cardiovascular mortality (OR 1.20, 95% CI 0.90-1.61, p=0.22), rate of heart failure (OR 1.17, 95% CI 0.86-1.59, p=0.31), CABG (OR 1.47, 95% CI 0.82-2.64, p=0.19), repeat MI (OR 1.23, 95% CI 0.92-1.63, p=0.17) and stroke (OR 1.27 95% CI 0.68-2.34, p=0.45%) were similar between the two groups. Conclusions: In contrast to the culprit-only approach, complete revascularization in patients with the acute coronary syndrome is associated with a significant reduction in MACE, angina and need for revascularization.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
