Islam Y Elgendy1, Tianyao Huo2, Ahmed Mahmoud3, Anthony A Bavry4. 1. Department of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL, 32610, USA. Electronic address: islam.elgendy@medicine.ufl.edu. 2. Department of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL, 32610, USA. Electronic address: thuo@ufl.edu. 3. Department of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL, 32610, USA. Electronic address: ahmed.mahmoud@medicine.ufl.edu. 4. Department of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL, 32610, USA; North Florida/South Georgia Veterans Health Systems, 1601 SW Archer Road, Gainesville, FL 32608, USA. Electronic address: anthony.bavry@va.gov.
Abstract
BACKGROUND: The best approach for revascularization of multi-vessel coronary disease in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) is controversial. METHODS: We searched the Medline and Web of Science databases, the Cochrane Register of Controlled Trials, and major conference proceedings for clinical trials that randomized STEMI patients with multi-vessel disease to a complete versus culprit-only revascularization strategy. Random effects summary risk ratios (RR) were constructed using a DerSimonian-Laird model. RESULTS: A total of 6 trials met our selection criteria, which yielded 1,190 patients. The mean follow-up duration was 20.5 months. The incidence of major adverse cardiac events was significantly reduced in the complete revascularization group versus the culprit-only revascularization group (RR 0.57, 95% confidence interval (CI) 0.41-0.78, p < 0.001). This was due to a lower risk of urgent revascularization with complete revascularization (RR 0.55, 95% CI 0.35-0.86, p = 0.01). A non-significant reduction was observed with complete versus culprit-only revascularization for the combined outcome of mortality or myocardial infarction (RR 0.56, 95% CI 0.30-1.04, p = 0.06). CONCLUSION: Complete revascularization of significant coronary lesions at the time of primary PCI in patients with STEMI and multi-vessel disease was associated with better outcomes. This was primarily due to a reduction in the need for urgent revascularization. Larger trials are needed to determine if complete revascularization reduces death or myocardial infarction.
BACKGROUND: The best approach for revascularization of multi-vessel coronary disease in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) is controversial. METHODS: We searched the Medline and Web of Science databases, the Cochrane Register of Controlled Trials, and major conference proceedings for clinical trials that randomized STEMI patients with multi-vessel disease to a complete versus culprit-only revascularization strategy. Random effects summary risk ratios (RR) were constructed using a DerSimonian-Laird model. RESULTS: A total of 6 trials met our selection criteria, which yielded 1,190 patients. The mean follow-up duration was 20.5 months. The incidence of major adverse cardiac events was significantly reduced in the complete revascularization group versus the culprit-only revascularization group (RR 0.57, 95% confidence interval (CI) 0.41-0.78, p < 0.001). This was due to a lower risk of urgent revascularization with complete revascularization (RR 0.55, 95% CI 0.35-0.86, p = 0.01). A non-significant reduction was observed with complete versus culprit-only revascularization for the combined outcome of mortality or myocardial infarction (RR 0.56, 95% CI 0.30-1.04, p = 0.06). CONCLUSION: Complete revascularization of significant coronary lesions at the time of primary PCI in patients with STEMI and multi-vessel disease was associated with better outcomes. This was primarily due to a reduction in the need for urgent revascularization. Larger trials are needed to determine if complete revascularization reduces death or myocardial infarction.
Authors: Claudio A Bravo; Sameer A Hirji; Deepak L Bhatt; Rachna Kataria; David P Faxon; E Magnus Ohman; Kevin L Anderson; Akil I Sidi; Michael H Sketch; Stuart W Zarich; Asishana A Osho; Christian Gluud; Henning Kelbæk; Thomas Engstrøm; Dan Eik Høfsten; James M Brennan Journal: Cochrane Database Syst Rev Date: 2017-05-03
Authors: Adaya Weissler-Snir; Chen Gurevitz; Abid Assali; Hana Vaknin-Assa; Tamir Bental; Adi Lador; Hagai Yavin; Leor Perl; Ran Kornowski; Eli Lev Journal: PLoS One Date: 2015-09-25 Impact factor: 3.240