Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: Meta-analysis of randomised controlled trials

Antonino Buffon, Mariusz Kowalewski, Volker Schulze, Sergio Berti, Ron Waksman, Jacek Kubica, Michalina Kołodziejczak, Harry Suryapranata, Paul Alfred Gurbel, Malte Kelm, Wojciech Pawliszak, Lech Anisimowicz, Eliano Pio Navarese

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Current guidelines recommend culpritonly revascularisation (COR) in haemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) disease. Contrarily, growing body of evidence available from recent randomised controlled trials (RCTs) demonstrates improved outcomes with complete MV-percutaneous coronary intervention (PCI). Methods and results: We performed a meta-analysis of RCTs comparing complete MV-PCI with non-complete MV-PCI in STEMI and MV disease. Complete MV-PCI was defined as revascularisation to non-infarct-related artery lesions during index procedure, non-complete MVPCI-encompassed COR and staged approaches. Multiple databases and congress proceedings from major cardiovascular societies' meetings were screened for relevant studies. Primary endpoint was the composite of major adverse cardiac events (MACE) typically defined as death, recurrent myocardial infarction (MI) and repeat revascularisation. Secondary endpoints were cardiovascular mortality, recurrent MI and repeat revascularisation. Outcomes were analysed at longest available follow-up with differences accounted for with adjusted models by person-years. Seven RCTs (N=1303) were included. The median follow-up was 12 months. Complete MV-PCI reduced the odds of MACE compared with non-complete MV-PCI (OR (95% CIs) 0.59 (0.36 to 0.97), p=0.04) driven by reduction in recurrent MI (0.48 (0.27 to 0.85), p=0.01) and repeat revascularisation (0.51 (0.31 to 0.84), p=0.008). Complete MV-PCI was associated with a non-significant trend towards reduced cardiovascular mortality (0.54 (0.26 to 1.10), p=0.09) as well. In a sensitivity analysis, none of the baseline clinical variables significantly influenced overall estimates. Conclusions: In STEMI and MV disease, complete MVPCI as compared with non-complete strategy reduces MACE by 41%, driven by a 52% reduction in recurrent MI and 49% reduction in repeat revascularisation.
Original languageEnglish
Pages (from-to)1309-1317
Number of pages9
JournalHeart
Volume101
DOIs
Publication statusPublished - 2015

Keywords

  • Coronary Artery Disease
  • Electrocardiography
  • Humans
  • Myocardial Infarction
  • Myocardial Revascularization
  • Outcome Assessment, Health Care
  • Percutaneous Coronary Intervention
  • Retreatment
  • Severity of Illness Index
  • Survival Analysis

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