Coronary Artery DiseaseMeta-Analysis Comparing Complete Revascularization Versus Infarct-Related Only Strategies for Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease
Section snippets
Methods
This meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses.17 A computerized literature review of PubMed, Google Scholar, and the Cochrane databases was conducted to locate relevant studies. The following keywords were used: “ST-elevation myocardial infarction,” “multivessel,” “complete,” “staged,” “infarct-related artery,” “revascularization,” “percutaneous coronary intervention,” and
Results
Nine RCTs met the criteria for inclusion; these studies included 2,176 patients. Supplementary Figure S1 shows the search flow diagram. Supplementary Figure S2 shows the network of treatment comparisons. Table 1 describes the characteristics of the individual trials. IRA-OR was compared with CR-IP in 2 RCTs and with CR-SP in 3 RCTs.3, 6, 7, 10, 11 Two trials compared all 3 revascularization strategies.5, 8 In 2 trials, all patients underwent CR either during IP or as an SP.4, 9 Follow-up
Discussion
This updated meta-analysis of 9 RCTs involved the largest number (2,176) of patients ever reported. These data showed that in patients with STEMI and MV CAD, CR either during primary PCI or as an SP was associated with lower occurrence of MACE, revascularization, and CV mortality than IRA-OR. Furthermore, CR during primary PCI was also associated with a lower rate of recurrent MI. However, there was no difference in all-cause mortality. In CR-IP, larger volumes of contrast were used than in
Disclosures
Dr. Rao is a consultant for Terumo Interventional Systems, Astra Zeneca, Merck and Medtronic. The other authors have no conflicts of interest to disclose.
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Cited by (25)
Immediate versus staged complete revascularization in acute coronary syndrome: A meta-analysis of randomized controlled trials
2023, International Journal of CardiologyPercutaneous Coronary Intervention in Multi-Vessel Disease
2022, Cardiovascular Revascularization MedicinePercutaneous complete revascularization strategies using sirolimus-eluting biodegradable polymer-coated stents in patients presenting with acute coronary syndrome and multivessel disease: Rationale and design of the BIOVASC trial
2020, American Heart JournalCitation Excerpt :Two other meta-analyses by Tarantini et al and Li et al confirmed this clinical penalty for immediate complete PCI versus culprit-only or staged complete in STEMI.29,30 Conversely, other meta-analyses demonstrated lower rates of recurrent MI with immediate versus staged complete PCI.31,32 Another meta-analysis including only 4 randomized trials with STEMI or NSTEMI patients suggested more repeat revascularizations and a trend toward more MACE with staged versus immediate complete PCI.33
Meta-Analysis of Optimal Revascularization Strategy for Patients With ST-Segment Elevation Myocardial Infarction and Multi-Vessel Coronary Artery Disease
2020, American Journal of CardiologyCitation Excerpt :However, in the last decade, several RCTs have suggested that CR improves outcomes compared with IRA-OR. Similarly, several meta-analyses have shown that CR decreases the MACE rate and that this is predominantly driven by a lower rate of revascularization.21–25 However, since those meta-analyses, new RCTs, including the COMPLETE trial—the largest RCT examining revascularization strategies in STEMI, enrolling more patients individually than the previous ten trials combined—have been reported, rendering previous meta-analyses arguably outdated.21–23
Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: A meta-analysis of randomized controlled trials
2020, IJC Heart and VasculatureCitation Excerpt :It should be appreciated that the evidence for significant clinical benefit from CR over and above culprit-only revascularization was not clear from the older data [9–11,13,14,21–23]. Older trials and meta analyses did not support an additional benefit from CR, probably because of different inclusion criteria of patients and studies as well as different means for measuring clinical outcome [29–37]. We believe that the results of the current meta analysis are of clinical relevance based on reduced MACE at mid-term follow up which is what concerns most patients.
All authors listed in the manuscript had access to the data and a role in preparing the manuscript.
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