Multi-vessel versus culprit-vessel and staged percutaneous coronary intervention in STEMI patients with multivessel disease: a meta-analysis of randomized controlled trials.

Abstract

Percutaneous coronary intervention (PCI) is preferred in patients with acute ST-elevation myocardial infarction (STEMI). In patients with acute STEMI with multivessel disease (MVD), the guidelines recommend culprit vessel PCI (CV-PCI) in the absence of hemodynamic instability. We performed a meta-analysis of all randomized controlled trials (RCTs) comparing multi-vessel PCI (MV-PCI) with CV-PCI or staged PCI (S-PCI) in patients with acute STEMI and MVD. PubMed, EMBASE and CENTRAL were searched for publications since inception to December 2013. Random effects model was used to compute summary effects. Four RCTs (840 patients) were identified. MV-PCI compared to CV-PCI significantly reduced the risks of major adverse cardiac events (MACE)-a composite of MI, revascularization and all-cause mortality (RR: 0.46, 95% CI: 0.35-0.60, P<0.00001) by reducing the risks of MI (0.35, 0.17-0.71, P=0.004) and revascularization (0.35, 0.24-0.52, P<0.00001). The risk of all-cause mortality was not different (0.69, 0.39-1.21, P=0.19). S-PCI and MV-PCI had similar risks of MACE (0.96, 0.59-1.57, P=0.87), MI (0.60, 0.20-1.78, P=0.36), revascularization (0.86, 0.47-1.54, P=0.60) and all-cause mortality (1.50, 0.44-5.07, P=0.57). MV-PCI compared to CV-PCI resulted in lower risks of MACE driven by lower MI and revascularization in patients with STEMI and multi-vessel disease.