Clinical Research
Interventional Cardiology
Culprit Vessel Only Versus Multivessel and Staged Percutaneous Coronary Intervention for Multivessel Disease in Patients Presenting With ST-Segment Elevation Myocardial Infarction: A Pairwise and Network Meta-Analysis

https://doi.org/10.1016/j.jacc.2011.03.046Get rights and content
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Objectives

The purposes of this study were to investigate whether, in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), percutaneous coronary intervention (PCI) should be confined to the culprit or also nonculprit vessels and, when performing PCI for nonculprit vessels, whether it should take place during primary PCI or staged procedures.

Background

A significant percentage of STEMI patients have MVD. However, the best PCI strategy for nonculprit vessel lesions is unknown.

Methods

Pairwise and network meta-analyses were performed on 3 PCI strategies for MVD in STEMI patients: 1) culprit vessel only PCI strategy (culprit PCI), defined as PCI confined to culprit vessel lesions only; 2) multivessel PCI strategy (MV-PCI), defined as PCI of culprit vessel as well as ≥1 nonculprit vessel lesions; and 3) staged PCI strategy (staged PCI), defined as PCI confined to culprit vessel, after which ≥1 nonculprit vessel lesions are treated during staged procedures. Prospective and retrospective studies were included when research subjects were patients with STEMI and MVD undergoing PCI. The primary endpoint was short-term mortality.

Results

Four prospective and 14 retrospective studies involving 40,280 patients were included. Pairwise meta-analyses demonstrated that staged PCI was associated with lower short- and long-term mortality as compared with culprit PCI and MV-PCI and that MV-PCI was associated with highest mortality rates at both short- and long-term follow-up. In network analyses, staged PCI was also consistently associated with lower mortality.

Conclusions

This meta-analysis supports current guidelines discouraging performance of multivessel primary PCI for STEMI. When significant nonculprit vessel lesions are suitable for PCI, they should only be treated during staged procedures.

Key Words

acute myocardial infarction
multivessel disease
percutaneous coronary intervention

Abbreviations and Acronyms

CABG
coronary artery bypass graft surgery
MV
multivessel
MVD
multivessel disease
OR
odds ratio
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

Ms. van Valkenhoef has received funding from the project Eschen (T6-202) of Top Institute Pharma (the Netherlands). All other authors have reported that they have no relationships to disclose.