Key result
Complete revascularization with percutaneous coronary intervention was superior to culprit-only revascularization for reducing cardiovascular death (RR 0.68; 95% CI 0.47-0.98; P=0.037).
Why the study?
For patients with STEMI and multivessel CAD, the optimal treatment of the non-infarct-related artery has remained controversial.
Does complete revascularization with percutaneous coronary intervention reduce cardiovascular death in patients with STEMI and multivessel coronary artery disease?
Meta-Analysis (n=7,542)
Does complete revascularization with percutaneous coronary intervention reduce cardiovascular death in patients with STEMI and multivessel coronary artery disease?
Relative Risk: 0.68 (95% CI 0.47–0.98)
p-value: p=0.037
In patients with STEMI and multivessel disease, complete revascularization significantly reduces the risk of cardiovascular death and myocardial infarction compared to culprit-lesion-only PCI.
Supports complete revascularization to reduce cardiovascular death in STEMI with multivessel disease; reinforces and extends RCT evidence for guideline-directed care.
Background For patients with ST‐segment–elevation myocardial infarction ( STEMI ) and multivessel coronary artery disease, the optimal treatment of the non‐infarct‐related artery has been controversial. This up‐to‐date meta‐analysis focusing on individual clinical end points was performed to further evaluate the benefit of complete revascularization with percutaneous coronary intervention for patients with STEMI and multivessel coronary artery disease. Methods and Results We systematically identified all randomized trials comparing complete revascularization with percutaneous coronary intervention to culprit‐only revascularization for multivessel disease in STEMI and performed a random‐effects meta‐analysis. The primary efficacy end point was cardiovascular death analyzed on an intention‐to‐treat basis. Secondary end points included all‐cause mortality, myocardial infarction, and unplanned revascularization. Ten studies (7542 patients) were included: 3664 patients were randomized to complete revascularization and 3878 to culprit‐only revascularization. Across all patients, complete revascularization was superior to culprit‐only revascularization for reduction in the risk of cardiovascular death (relative risk [RR], 0.68; 95% CI , 0.47–0.98; P =0.037; I 2 =21.8%) and reduction in the risk of myocardial infarction (RR, 0.65; 95% CI , 0.54–0.79; P <0.0001; I 2 =0.0%). Complete revascularization also significantly reduced the risk of unplanned revascularization (RR, 0.37; 95% CI , 0.28–0.51; P <0.0001; I 2 =64.7%). The difference in all‐cause mortality with percutaneous coronary intervention was not statistically significant (RR, 0.85; 95% CI , 0.69–1.04; P =0.108; I 2 =0.0%). Conclusions For patients with STEMI and multivessel disease, complete revascularization with percutaneous coronary intervention significantly improves hard clinical outcomes including cardiovascular death and myocardial infarction. These data have implications for clinical practice guidelines regarding recommendations for complete revascularization following STEMI .
No takes yet. Share an insight, caveat, or question.
Ahmad et al. (2020) conducted a meta-analysis in ST-segment-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (n=7,542). Complete revascularization with percutaneous coronary intervention vs. Culprit-only revascularization was evaluated on Cardiovascular death (RR 0.68, 95% CI 0.47-0.98, p=0.037). Complete revascularization with percutaneous coronary intervention was superior to culprit-only revascularization for reducing cardiovascular death (RR 0.68; 95% CI 0.47-0.98; P=0.037).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: