Staged versus immediate complete vessel revascularization in patients presenting with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Abstract

Abstract Funding Acknowledgements None. Introduction In patients presenting with acute coronary syndrome (ACS) ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) is the preferred modality of reperfusion. However, these patients may also have multivessel coronary artery disease (CAD) on coronary angiography which is associated with higher risk of mortality. Current guidelines recommend complete revascularization in STEMI with multivessel CAD, however this poses a high risk for major acute cardiovascular events (MACE). Other available reperfusion strategies include staged vessel revascularization. This meta-analysis aims to determine if staged vessel revascularization can be a better mode of reperfusion strategy in patients with STEMI with multivessel CAD. Methods A comprehensive search of randomized controlled trials (RCT) was conducted with the use of staged versus immediate complete vessel revascularization in patients with STEMI. Outcome measures to assess the effectiveness of these techniques were all-cause mortality, MACE and target vessel revascularization. The analyses were done using random effects analysis model by mantel-haenszel statistical method via Review Manager V5.4. Results There were five studies included in the meta-analysis with 1,483 subjects analyzed. There was 26% less risk of all-cause mortality (RR 0.74 [95% CI: 0.41-1.31]) and 6% less risk for MACE (RR 0.94 [95% CI: 0.58-1.52]) in staged revascularization compared to immediate complete revascularization. In terms of target-vessel revascularization there was no statistical difference between the two treatment strategies (RR 1.02 [95% CI: 0.57-1.83]). Conclusion Staged and immediate complete vessel revascularization have similar rates of target-vessel revascularization among patients presenting with STEMI. However, staged vessel revascularization showed lower rates of all-cause mortality and MACE, which suggest that this treatment strategy may be a preferable type of revascularization in patients presenting with STEMI with multivessel CAD.