Key result
Culprit-only PCI cuts short-term mortality ~50% vs. immediate multivessel PCI in STEMI.
Why the study?
The optimal PCI strategy for STEMI patients with multivessel disease undergoing primary PCI in the acute phase is not well established.
Does multivessel percutaneous coronary intervention improve outcomes compared to culprit vessel only percutaneous coronary intervention in patients with STEMI and multivessel disease?
Meta-Analysis (n=39,390)
Does multivessel percutaneous coronary intervention improve outcomes compared to culprit vessel only percutaneous coronary intervention in patients with STEMI and multivessel disease?
Odds Ratio: 0.5 (95% CI 0.32–0.77)
Absolute Event Rate: 4.83% vs 6.93%
p-value: p=0.002
In patients with STEMI and multivessel disease, multivessel PCI during the index procedure is associated with increased short- and long-term mortality compared to culprit-vessel-only PCI, supporting current guidelines to defer non-culprit intervention.
Culprit-only PCI was associated with lower short-term mortality than MV-PCI in STEMI with MVD; leaves open need for contemporary RCTs.
BACKGROUND: The best strategy for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD), who underwent primary percutaneous coronary intervention (PCI) in the acute phase, is not well established. OBJECTIVES: Our goal was to conduct a meta-analysis comparing culprit vessel only percutaneous coronary intervention (culprit PCI) with multivessel percutaneous coronary intervention (MV-PCI) for treatment of patients with STEMI and MVD. METHODS: Pubmed, Elsevier, Embase, and China National Knowledge Infrastructure (CNKI) databases were systematically searched for randomized and nonrandomized studies comparing culprit PCI and MV-PCI strategies during the index procedure. A meta-analysis was performed using Review Manager 5.1 (Cochrane Center, Denmark). RESULTS: Four randomized and fourteen nonrandomized studies involving 39,390 patients were included. MV-PCI strategy is associated with an increased short-term mortality (OR: 0.50, 95% CI: 0.32 to 0.77, p = 0.002), long-term mortality (OR: 0.52, 95% CI: 0.36 to 0.74, p<0.001), and risk of renal dysfunction (OR: 0.77, 95% CI: 0.61 to 0.97, p = 0.03) compared with culprit PCI strategy, while it reduced the incidence of revascularization (OR: 2.65, 95% CI: 1.80 to 3.90, p<0.001). CONCLUSIONS: This meta-analysis supports current guidelines which indicate that the non-culprit vessel should not be treated during the index procedure.
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Zhang et al. (2014) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) (n=39,390). Culprit vessel only percutaneous coronary intervention (culprit PCI) vs. Multivessel percutaneous coronary intervention (MV-PCI) was evaluated on Short-term mortality (in-hospital or 30-day death) (OR 0.50, 95% CI 0.32 to 0.77, p=0.002). Culprit vessel only percutaneous coronary intervention reduced short-term mortality (OR 0.50) and long-term mortality (OR 0.52) compared to multivessel intervention during the index procedure in patients with STEMI and multivessel disease.
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