Introduction: Appropriate management for patients with multi vessel coronary disease presenting with St Segment Elevation Myocardial Infarction (STEMI) remains to be defined. Methods: Medline and Cochrane Library were searched for randomized controlled trials (RCTs) or observational studies adjusted with multivariate analysis reporting about STEMI patients with multivessel coronary disease treated with culprit only or with complete revascularization, excluding those in cardiogenic shock. Prespecified analysis were performed according to strategy of complete revascularization, either during the same procedure of primary Percutaneous Coronary Intervention (PCI) or during index hospitalization. MACE (death or myocardial infarction or revascularization) at follow up was the primary end point, its single components and 90 days MACE the secondary ones. Results: 9 studies (4 RCTS) with 4486 patients compared culprit only and complete PCI performed during the primary PCI. Rates MACE did not differ at 90 days (OR 1.39 [0.79-2.46] I2 0%) and after a follow up of 1 year (OR 0.70 [0.38, 1.27] I2 0%) as those of its single components, apart from a reduction for repeated revascularization for complete PCI (OR 0.62 [0.39, 0.98] I2 0%). 6 studies (1 RCT) with 5855 patients compared culprit only lesions and complete PCI during index hospitalization. In hospital and after 1 year MACE rates did not differ (OR 0.90 [0.67, 1.21] I2 0%), with a similar benefit regarding repeated revascularization (0.60 [0.40, 0.90] I2 0%, all Confidence Interval 95%). Conclusions: Complete revascularization performed during primary PCI or index hospitalizations for patients presenting with STEMI appears safe at short term follow up and offers a reduction for repeated revascularization at one year.
Management of multivessel coronary disease in STEMI patients; a systematic review and meta-analysis
QUADRI, Giorgio;D'ASCENZO, FABRIZIO;GAITA, Fiorenzo
2014-01-01
Abstract
Introduction: Appropriate management for patients with multi vessel coronary disease presenting with St Segment Elevation Myocardial Infarction (STEMI) remains to be defined. Methods: Medline and Cochrane Library were searched for randomized controlled trials (RCTs) or observational studies adjusted with multivariate analysis reporting about STEMI patients with multivessel coronary disease treated with culprit only or with complete revascularization, excluding those in cardiogenic shock. Prespecified analysis were performed according to strategy of complete revascularization, either during the same procedure of primary Percutaneous Coronary Intervention (PCI) or during index hospitalization. MACE (death or myocardial infarction or revascularization) at follow up was the primary end point, its single components and 90 days MACE the secondary ones. Results: 9 studies (4 RCTS) with 4486 patients compared culprit only and complete PCI performed during the primary PCI. Rates MACE did not differ at 90 days (OR 1.39 [0.79-2.46] I2 0%) and after a follow up of 1 year (OR 0.70 [0.38, 1.27] I2 0%) as those of its single components, apart from a reduction for repeated revascularization for complete PCI (OR 0.62 [0.39, 0.98] I2 0%). 6 studies (1 RCT) with 5855 patients compared culprit only lesions and complete PCI during index hospitalization. In hospital and after 1 year MACE rates did not differ (OR 0.90 [0.67, 1.21] I2 0%), with a similar benefit regarding repeated revascularization (0.60 [0.40, 0.90] I2 0%, all Confidence Interval 95%). Conclusions: Complete revascularization performed during primary PCI or index hospitalizations for patients presenting with STEMI appears safe at short term follow up and offers a reduction for repeated revascularization at one year.
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