Rita Pavasini1, Simone Biscaglia1, Emanuele Barbato2, Matteo Tebaldi1, Dariusz Dudek3,4, Javier Escaned5, Gianni Casella6, Andrea Santarelli7, Vincenzo Guiducci8, Enrique Gutierrez-Ibanes9,10, Giuseppe Di Pasquale6, Luigi Politi11, Andrea Saglietto12, Fabrizio D'Ascenzo12, Gianluca Campo1,4. 1. Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy. 2. Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via Pansini, Naples 80131, Italy. 3. Institute of Cardiology, Jagiellonian University Medical College, ul. Sw Anny 12, Krakow 31-008, Poland. 4. Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola 48033, Italy. 5. Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Calle del Prof Martin Lagos s/n, Madrid 28040, Spain. 6. U.O.C. Cardiologia, Ospedale Maggiore, Largo Nigrisoli 2, Bologna 40133, Italy. 7. Cardiovascular Department, Infermi Hospital, Viale Luigi Settembrini 2, Rimini 47923, Italy. 8. Interventional Cardiology Unit, S. Maria Nuova Hospital, Viale Risorgimento 80, Reggio Emilia 42123, Italy. 9. Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Calle del Dr Esquerdo 46, Madrid 28007, Spain. 10. Universidad Carlos III, Calle Madrid 126 Madrid 28903 Spain. 11. Cardiologia Interventistica, ASST Rhodense, Corso Europa 250, Rho 20024, Italy. 12. Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin 10126, Italy.
Abstract
AIMS: The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). METHODS AND RESULTS: Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39-0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36-150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55-0.84, I2 = 0% and HR 0.29, 95% CI 0.22-0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37-55) for MI and 8 (95% CI 5-13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56-1.16, I2 = 27%) was not affected by the revascularization strategy. CONCLUSION: In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). METHODS AND RESULTS: Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39-0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36-150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55-0.84, I2 = 0% and HR 0.29, 95% CI 0.22-0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37-55) for MI and 8 (95% CI 5-13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56-1.16, I2 = 27%) was not affected by the revascularization strategy. CONCLUSION: In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Gani Bajraktari; Ibadete Bytyçi; Michael Y Henein; Fernando Alfonso; Ali Ahmed; Haki Jashari; Deepak L Bhatt Journal: Int J Cardiol Heart Vasc Date: 2020-06-13
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