Complete Revascularization Techniques for Acute Myocardial Infarction: A Systematic Review and Meta‐Analysis Comparing Angiography‐ and Coronary Physiology‐Guided PCI

Background: It is generally accepted that for patients with multivessel disease and myocardial infarction, complete revascularization is preferable than culprit‐only revascularization. However, existing studies comparing coronary physiology‐guided versus angiography‐guided complete revascularization percutaneous coronary intervention (PCI) present conflicting conclusions. Methods: The investigation involved a comprehensive search of PubMed/Medline, Embase, and the Cochrane library for studies comparing coronary physiology‐guided with angiography‐guided PCI in patients with MI‐MVD. Clinical endpoints, including major adverse cardiovascular events, all‐cause mortality, recurrent MI, major adverse cardiac and cerebral event, planned revascularization, repeated revascularization, average stent number per patient, heart failure, and contrast nephropathy during any follow‐up period post PCI, were considered for analysis. Odds ratios (ORs) and mean differences with 95% confidence intervals (CIs) were calculated for binary and continuous variables, respectively. The analyses were conducted using Review Manager 5.1. Results: Our analysis included a total of 2493 patients from 5 studies. The physiology‐guided PCI group exhibited a lower rate of planned revascularization (OR: 0.10, 95% CIs: 0.07–0.14, p ≤ 0.001, and I 2 = 96.6%) and average stent number per patient (mean difference: −0.47, 95% CIs: −0.56–−0.38, p ≤ 0.001, and I 2 = 58.6%). However, there were no significant differences between the two groups regarding major adverse cardiac event (MACE) (OR: 0.89, 95% CIs: 0.63–1.26, p = 0.520, and I 2 = 67.8%), all‐cause mortality (OR: 0.65, 95% CIs: 0.38–1.12, p = 0.120, and I 2 = 50.5%), recurrent MI (OR: 0.74, 95% CIs: 0.28–2.00, p = 0.558, and I 2 = 77.2%), major adverse cardiac and cerebral event (MACCE) (OR = 0.77, 95% CIs: 0.43–1.37, p = 0.378, and I 2 = 0%), repeated revascularization (OR = 1.47, 95% CIs: 0.54–3.99, p = 0.452, and I 2 = 76.5%), heart failure (OR: 1.04, 95% CIs: 0.43–2.56, p = 0.924, and I 2 = 0%), and contrast nephropathy (OR: 1.26, 95% CIs: 0.27–5.81, p = 0.766, and I 2 = 0%). Conclusions: Among patients with MI‐MVD, physiology‐guided PCI appeared to reduce the need for planned revascularization without triggering repeated revascularization, leading to fewer stents compared with angiography‐guided PCI. Other prespecified clinical outcomes including MACE, all‐cause mortality, recurrent MI, MACCE, heart failure, and contrast nephropathy were not significantly different between these two approaches.