Vincenzo Pasceri1, Giuseppe Patti2, Francesco Pelliccia3, Carlo Gaudio3, Giulio Speciale4, Roxana Mehran5, George D Dangas5. 1. San Filippo Neri Hospital, Rome, Italy; La Sapienza University, Rome, Italy. Electronic address: vpasceri@hotmail.com. 2. Campus Bio-Medico University, Rome, Italy. 3. La Sapienza University, Rome, Italy. 4. San Filippo Neri Hospital, Rome, Italy; La Sapienza University, Rome, Italy. 5. Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Cardiovascular Research Foundation, New York, New York.
Abstract
OBJECTIVES: The aim of this study was to compare complete revascularization with a culprit-only strategy in patients presenting with ST-segment elevation myocardial infarction (MI) and multivessel disease by a meta-analysis of randomized trials. BACKGROUND: Although several trials have compared complete with culprit-only revascularization in ST-segment elevation MI, it remains unclear whether complete revascularization may lead to improvement in hard endpoints (death and MI). METHODS: Randomized trials comparing complete revascularization with culprit-only revascularization in patients with ST-segment elevation MI without cardiogenic shock were identified by a systematic search of published research. Random-effects meta-analysis was performed, comparing clinical outcomes in the 2 groups. RESULTS: Eleven trials were identified, including a total of 3,561 patients. Compared with a culprit-only strategy, complete revascularization significantly reduced risk for death or MI (relative risk [RR]: 0.76; 95% confidence interval [CI]: 0.58 to 0.99; p = 0.04). Meta-regression showed that performing complete revascularization at the time of primary percutaneous coronary intervention (PCI) was associated with better outcomes (p = 0.016). The 6 trials performing complete revascularization during primary PCI (immediate revascularization) were associated with a significant reduction in risk for both total mortality (RR: 0.62; 95% CI: 0.39 to 0.97; p = 0.03) and MI (RR: 0.40; 95% CI: 0.25 to 0.66; p < 0.001), whereas the 5 trials performing only staged revascularization did not show any significant benefit in either total mortality (RR: 1.02; 95% CI: 0.65 to 1.62; p = 0.87) or MI (RR: 1.04; 95% CI: 0.48 to 1.68; p = 0.86). CONCLUSIONS: When feasible, complete revascularization with PCI can significantly reduce the combined endpoint of death and MI. Complete revascularization performed during primary PCI was also associated with significant reductions in both total mortality and MI, whereas staged revascularization did not improve these outcomes.
OBJECTIVES: The aim of this study was to compare complete revascularization with a culprit-only strategy in patients presenting with ST-segment elevation myocardial infarction (MI) and multivessel disease by a meta-analysis of randomized trials. BACKGROUND: Although several trials have compared complete with culprit-only revascularization in ST-segment elevation MI, it remains unclear whether complete revascularization may lead to improvement in hard endpoints (death and MI). METHODS: Randomized trials comparing complete revascularization with culprit-only revascularization in patients with ST-segment elevation MI without cardiogenic shock were identified by a systematic search of published research. Random-effects meta-analysis was performed, comparing clinical outcomes in the 2 groups. RESULTS: Eleven trials were identified, including a total of 3,561 patients. Compared with a culprit-only strategy, complete revascularization significantly reduced risk for death or MI (relative risk [RR]: 0.76; 95% confidence interval [CI]: 0.58 to 0.99; p = 0.04). Meta-regression showed that performing complete revascularization at the time of primary percutaneous coronary intervention (PCI) was associated with better outcomes (p = 0.016). The 6 trials performing complete revascularization during primary PCI (immediate revascularization) were associated with a significant reduction in risk for both total mortality (RR: 0.62; 95% CI: 0.39 to 0.97; p = 0.03) and MI (RR: 0.40; 95% CI: 0.25 to 0.66; p < 0.001), whereas the 5 trials performing only staged revascularization did not show any significant benefit in either total mortality (RR: 1.02; 95% CI: 0.65 to 1.62; p = 0.87) or MI (RR: 1.04; 95% CI: 0.48 to 1.68; p = 0.86). CONCLUSIONS: When feasible, complete revascularization with PCI can significantly reduce the combined endpoint of death and MI. Complete revascularization performed during primary PCI was also associated with significant reductions in both total mortality and MI, whereas staged revascularization did not improve these outcomes.
Authors: Mohammed Osman; Safi U Khan; Peter D Farjo; Noor Chima; Babikir Kheiri; Firas Zahr; Mohamad Alkhouli Journal: Am J Cardiol Date: 2019-11-19 Impact factor: 2.778
Authors: Roberto C Cerrud-Rodriguez; Syed Muhammad Ibrahim Rashid; Karlo A Wiley; Maday Gonzalez; Valeriia A Kosmacheva; Isabella Castillero-Norato; Cornelia Rivera; Pedro Villablanca; Jose Wiley Journal: Int J Gen Med Date: 2021-06-03
Authors: Krishnaraj Sinhji Rathod; Marco Spagnolo; Mark K Elliott; Anne-Marie Beirne; Elliot J Smith; Rajiv Amersey; Charles Knight; Roshan Weerackody; Andreas Baumbach; Anthony Mathur; Daniel A Jones Journal: Clin Med Insights Cardiol Date: 2020-08-21