Angiography-guided complete revascularization significantly reduced major adverse cardiovascular events compared to culprit-only PCI (OR 0.44; 95% CI 0.37-0.52).
Meta-Analysis (n=11,568)
Does angiography-guided or physiology-guided complete revascularization reduce MACE compared to culprit-only PCI in STEMI patients with multivessel disease?
Angiography-guided complete revascularization appears to provide the best overall outcomes for STEMI patients with multivessel disease, outperforming physiology-guided CR and culprit-only PCI.
Odds Ratio: 0.44 (95% CI 0.37–0.52)
Background: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), complete revascularization (CR) is recommended over culprit-only PCI to reduce adverse cardiovascular outcomes. However, the optimal strategy for CR, whether angiography (Angio)-guided or physiology-guided, remains uncertain. Methods: This network meta-analysis included 14 randomized controlled trials (RCTs) with 11,568 patients to compare the efficacy of angio-guided CR, physiology-guided CR, and culprit-only PCI in reducing major adverse cardiovascular events (MACE), all-cause mortality, recurrent myocardial infarction (MI), cardiovascular (CV) death, and unplanned revascularization. The frequentist and Bayesian approaches were applied to assess the effectiveness of each strategy. Results: The pairwise meta-analysis showed that angio-guided CR showed superior efficacy, significantly reducing MACE (OR = 0.44; 95% CI: 0.37–0.52), recurrent myocardial infarction, and unplanned revascularization compared to culprit-only PCI. Physiology-guided CR also reduced MACE (OR = 0.64, 95% CI: 0.45–0.91) and unplanned revascularization. The network metanalysis showed that CV death was lower in the physiology-guided CR group (OR 0.56; 95% CI 0.25–1.05), suggesting a protective effect, but the difference did not reach statistical significance. Furthermore, physiology-guided CR was not significantly better than angio-guided CR in most outcomes. Conclusions: Angio-guided CR appears to provide the best overall outcomes for patients with STEMI and MVD, outperforming physiology-guided CR in most endpoints. Further large-scale trials are needed to clarify the relative efficacy of angio-guided CR and physiology-guided CR in this patient population.
Martino et al. (Thu,) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) (n=11,568). Angiography-guided or physiology-guided complete revascularization vs. Culprit-only PCI was evaluated on Major adverse cardiovascular events (MACE) (OR 0.44, 95% CI 0.37-0.52). Angiography-guided complete revascularization significantly reduced major adverse cardiovascular events compared to culprit-only PCI (OR 0.44; 95% CI 0.37-0.52).