Optimal reperfusion strategy in patients with acute STEMI and multivessel disease-an updated meta-analysis.

Abstract

This meta-analysis compared the efficacy and safety of culprit-only revascularization (COR) and complete revascularization (CR) in the treatment of patients with acute ST-elevation myocardial infarction (STEMI) and multivessel disease to determine the optimal reperfusion strategy. We analyzed published multicenter randomized controlled trials to compare COR and CR in patients with acute STEMI and multivessel disease. The PubMed, Cochrane Library, and Ovid databases were searched, and the meta-analysis was performed using Review Manager5.3 software. Eight multicenter randomized controlled trials were selected involving 2870 patients, of whom 1604 underwent COR and 1266 underwent CR. No significant heterogeneity was identified across these selected studies. The CR strategy significantly decreased the incidence of major adverse cardiac events (MACE; odds ratio [OR]: 2.44, 95% CI [95% confidence interval]: 1.96-3.03, p < 0.001), mortality (OR: 1.76, 95% CI: 1.25-2.47, p = 0.001), myocardial infarction (MI, OR: 1.62, 95% CI: 1.12-2.35, p = 0.01), and repeat revascularization (OR: 3.20, 95% CI: 2.41-4.24, p < 0.001) compared with the COR approach. Moreover, no significant difference was identified in the safety indexes, including contrast-induced nephropathy, stroke, and bleeding, between the CR and the COR group (p > 0.05). The present meta-analysis determined that CR is an efficacious and safe reperfusion strategy in patients with acute STEMI and multivessel disease.