Meta-Analysis of Culprit-Only Versus Multivessel Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Disease
Section snippets
Methods
We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials through May 31, 2017, for RCTs that enrolled patients with STEMI and MVD, and compared the following PCI strategies: (1) single-procedure multivessel PCI; (2) staged multivessel PCI; and (3) culprit-only PCI. The Medical Subject Headings terms are listed in Supplementary Table 1. There was no language restriction for the search. We kept the search current by setting up automated reminders from PubMed for new
Results
We identified 11 RCTs that enrolled 3,150 patients with STEMI and MVD (Supplementary Figure 1), who were followed for 1.6 ± 1.0 years (range 0.5 to 3.2 years), with a total of 5,296 patient-years of follow-up. The network of PCI strategy comparisons is shown in Figure 1. The baseline characteristics and bias risk assessments are outlined in Supplementary Tables 2 and 3. Two of the 11 trials included both a single-procedure and staged multivessel PCI strategy as part of the complete
Discussion
In the present meta-analysis of randomized trials of 3 different revascularization strategies in patients presenting with STEMI and MVD, single-procedure multivessel PCI was associated with a significant reduction in the composite rate of death or MI and repeat revascularization when compared with culprit-only PCI, with high consistency (no heterogeneity) between trials. Staged multivessel PCI was associated with a significant reduction in repeat revascularization, but not with death or MI when
Disclosures
The authors have no conflicts of interest to disclose.
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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
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