Abstract
AimsTo perform a pairwise meta-analysis of randomized controlled trials (RCTs) comparing multivessel percutaneous coronary intervention (PCI) and culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI) patients without cardiogenic shock.MethodsWe searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for RCTs comparing multivessel PCI with culprit vessel-only PCI in STEMI patients without cardiogenic shock and multivessel coronary artery disease. Only RCTs reporting mortality or myocardial reinfarction after at least 6 months following randomization were included. Hazard ratios (HRs) were pooled using random-effect models.ResultsNine RCTs were included in the final analysis. In total, 523 (8.3%) of 6314 patients suffered the combined primary endpoint of death or non-fatal reinfarction. This primary endpoint was significantly reduced with multivessel PCI compared to culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43–0.93; p = 0.03). This finding was driven by a reduction of non-fatal reinfarction (HR 0.64, 95% CI 0.52–0.79; p = 0.001), whereas no significant reduction of all-cause death (HR 0.77, 95% CI 0.44–1.35; p = 0.28) or cardiovascular death (HR 0.64, 95% CI 0.37–1.11; p = 0.09) was observed.ConclusionsIn STEMI patients without cardiogenic shock multivessel PCI reduced the risk of death or non-fatal reinfarction compared to culprit vessel-only PCI.
Highlights
50% of patients with ST-elevation myocardial infarction (STEMI) present with multivessel coronary artery disease at the time of primary percutaneous coronary intervention (PCI), which is associated with worse prognosis [1,2,3]
While earlier observational studies reported worse outcomes with multivessel revascularization performed during primary PCI, numerous randomized controlled trials (RCTs) conducted during the last years suggested a benefit of multivessel PCI over culprit vessel-only PCI [4,5,6,7,8,9,10]
We investigated the heterogeneity introduced by pooling studies investigating (a) different strategies for multivessel PCI, (b) fractional flow reserve (FFR)-guided versus angiography-guided multivessel PCI, and (c) all-cause death versus cardiovascular death as part of the composite endpoint of death or non-fatal myocardial reinfarction
Summary
50% of patients with ST-elevation myocardial infarction (STEMI) present with multivessel coronary artery disease at the time of primary percutaneous coronary intervention (PCI), which is associated with worse prognosis [1,2,3]. While earlier observational studies reported worse outcomes with multivessel revascularization performed during primary PCI, numerous randomized controlled trials (RCTs) conducted during the last years suggested a benefit of multivessel PCI over culprit vessel-only PCI [4,5,6,7,8,9,10]. The so far largest COMPLETE (The Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI) trial. We aimed to perform a meta-analysis of RCTs comparing the efficacy of multivessel revascularization compared to culprit vessel-only PCI in STEMI patients without cardiogenic shock Clinical Research in Cardiology (2020) 109:1381–1391 reported a significant reduction of the combined endpoint of cardiovascular death and new myocardial infarction [10].
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