Key result
Multivessel PCI was associated with significantly lower long-term mortality compared to culprit vessel PCI in NSTEMI patients (RR 0.746; 95% CI 0.644-0.865; P<0.001).
Why the study?
Multivessel disease is common in non-ST elevation myocardial infarction patients, but whether multivessel PCI is superior to culprit vessel PCI is unknown.
Does multivessel percutaneous coronary intervention improve mortality and reduce repeat revascularization compared to culprit vessel only percutaneous coronary intervention in non-ST elevation myocardial infarction patients with multivessel disease?
Meta-Analysis
Does multivessel percutaneous coronary intervention improve mortality and reduce repeat revascularization compared to culprit vessel only percutaneous coronary intervention in non-ST elevation myocardial infarction patients with multivessel disease?
In patients with NSTEMI and multivessel disease, multivessel PCI is associated with improved long-term mortality and reduced repeat revascularization compared to culprit-only PCI, though randomized trials are needed to confirm these findings.
Answers are grounded in this paper and cite their sources.
May support multivessel PCI consideration in NSTEMI multivessel disease; leaves open confirmation by randomized trials.
BACKGROUND: Multivessel disease is common in non-ST elevation myocardial infarction patients. However, whether multivessel percutaneous coronary intervention is superior to culprit vessel percutaneous coronary intervention is unknown. METHODS: A meta-analysis was conducted including studies that compared multivessel percutaneous coronary intervention (MV-PCI) and culprit vessel percutaneous coronary intervention among non-ST elevation myocardial infarction patients. Relative risk (RR) for mortality, myocardial infarction (MI), repeat revascularization and procedural complications was calculated using a random effects model. Seventeen studies were included in the meta-analysis. RESULTS: There was no difference in short-term outcomes for mortality (RR 0.917, 95% CI 0.613-1.371, P = .672), MI (RR 0.960, 95% CI 0.612-1.507, P = .861), and stent thrombosis (RR 1.338, 95% CI 0.655-2.733, P = .424). Long-term mortality and repeat revascularization was significantly lower in the MV-PCI group (RR 0.746, 95% CI 0.644-0.865, P < .001 and RR 0.775, 95% CI 0.629-0.954, P = .016), respectively. CONCLUSION: No significant difference was demonstrated between the 2 strategies in the short-term outcomes. However, long-term outcomes in the MV-PCI group were superior to culprit vessel percutaneous coronary intervention in non-ST elevation myocardial infarction patients with multivessel disease. Long-term outcomes included mortality, repeat revascularization, stent thrombosis, and MI. However, randomized controlled trials are needed to compare the safety and efficacy of these strategies.
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Khandait et al. (2025) conducted a meta-analysis in Non-ST elevation myocardial infarction. Multivessel percutaneous coronary intervention (MV-PCI) vs. Culprit vessel percutaneous coronary intervention was evaluated on Long-term mortality (RR 0.746, 95% CI 0.644-0.865, p=<.001). Multivessel PCI was associated with significantly lower long-term mortality compared to culprit vessel PCI in NSTEMI patients (RR 0.746; 95% CI 0.644-0.865; P<0.001).
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