Giuseppe Tarantini1, Gianpiero D'Amico2, Sorin J Brener3, Paola Tellaroli4, Marco Basile5, Alessandro Schiavo2, Marco Mojoli2, Chiara Fraccaro2, Alfredo Marchese5, Giuseppe Musumeci6, Gregg W Stone7. 1. Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. Electronic address: giuseppe.tarantini.1@gmail.com. 2. Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. 3. Department of Medicine, Cardiac Catheterization Laboratory, New York Methodist Hospital, New York, New York. 4. Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. 5. Anthea Hospital, GVM Care & Research, Cardiology Unit, Bari, Italy. 6. Papa Giovanni XXIII Hospital, Bergamo, Italy. 7. Columbia University Medical Center, New York Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, New York.
Abstract
OBJECTIVES: The authors conducted a systematic pairwise and network meta-analysis to assess optimal treatment strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MV-CAD) undergoing primary percutaneous coronary intervention (PCI). BACKGROUND: Patients with STEMI and MV-CAD have a worse prognosis than those with single-vessel CAD. The optimal revascularization strategy for these patients is uncertain. METHODS: Studies of revascularization strategies for MV-CAD in STEMI patients undergoing primary PCI published between 2001 and 2015 were identified using an electronic search. Pairwise and network meta-analyses were performed for 3 PCI strategies in prospective and retrospective studies: 1) infarct-related artery (IRA)-only PCI; 2) single procedure MV-PCI; and 3) staged MV-PCI. Information on study design, inclusion and exclusion criteria, and clinical outcomes was extracted. The outcomes of interest were short-term and long-term mortality. RESULTS: Thirty-two studies (13 prospective and 19 retrospective) with 54,148 patients (IRA-only PCI [n = 42,112], single procedure MV-PCI [n = 8,138], and staged MV-PCI [n = 3,898]) were included in the analysis. Pairwise meta-analyses showed that staged MV-PCI was associated with lower short-term and long-term mortality compared with both IRA-only PCI and single stage MV-PCI, whereas IRA-only PCI was associated with lower mortality compared with single stage MV-PCI. Staged MV-PCI was also associated consistently with improved survival in network analyses. CONCLUSIONS: The present systematic review and meta-analysis supports the hypothesis that in patients with MV-CAD presenting with STEMI undergoing primary PCI, a staged multivessel revascularization strategy may improve early and late survival.
OBJECTIVES: The authors conducted a systematic pairwise and network meta-analysis to assess optimal treatment strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MV-CAD) undergoing primary percutaneous coronary intervention (PCI). BACKGROUND:Patients with STEMI and MV-CAD have a worse prognosis than those with single-vessel CAD. The optimal revascularization strategy for these patients is uncertain. METHODS: Studies of revascularization strategies for MV-CAD in STEMI patients undergoing primary PCI published between 2001 and 2015 were identified using an electronic search. Pairwise and network meta-analyses were performed for 3 PCI strategies in prospective and retrospective studies: 1) infarct-related artery (IRA)-only PCI; 2) single procedure MV-PCI; and 3) staged MV-PCI. Information on study design, inclusion and exclusion criteria, and clinical outcomes was extracted. The outcomes of interest were short-term and long-term mortality. RESULTS: Thirty-two studies (13 prospective and 19 retrospective) with 54,148 patients (IRA-only PCI [n = 42,112], single procedure MV-PCI [n = 8,138], and staged MV-PCI [n = 3,898]) were included in the analysis. Pairwise meta-analyses showed that staged MV-PCI was associated with lower short-term and long-term mortality compared with both IRA-only PCI and single stage MV-PCI, whereas IRA-only PCI was associated with lower mortality compared with single stage MV-PCI. Staged MV-PCI was also associated consistently with improved survival in network analyses. CONCLUSIONS: The present systematic review and meta-analysis supports the hypothesis that in patients with MV-CAD presenting with STEMI undergoing primary PCI, a staged multivessel revascularization strategy may improve early and late survival.
Authors: Héctor Cubero-Gallego; Rafael Romaguera; Albert Ariza-Sole; Joan Antoni Gómez-Hospital; Angel Cequier Journal: Cardiovasc Diagn Ther Date: 2017-06
Authors: Ana Paula Susin Osório; Alexandre Schaan de Quadros; José Luiz da Costa Vieira; Vera Lucia Portal Journal: Arq Bras Cardiol Date: 2017-11-27 Impact factor: 2.000