Complete Versus Culprit-Only Revascularization for Patients With Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention: An Updated Meta-Analysis of Randomized Trials

Islam Y. Elgendy, Xuerong Wen, Ahmed Mahmoud, Anthony A. Bavry

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Objectives: To perform an updated meta-analysis to determine whether complete revascularization of significant coronary lesions at the time of primary percutaneous coronary intervention (PCI) would be associated with better outcomes compared with culprit-only revascularization. Background: Individual trials have demonstrated conflicting evidence regarding the optimum revascularization strategy at the time of primary PCI. Methods: Clinical trials that randomized ST elevation myocardial infarction (STEMI) patients with multi-vessel disease to a complete versus culprit-only revascularization strategy were included. Random effects summary risk ratios (RR) were constructed using a DerSimonian–Laird model. The primary outcome of interest was mortality or myocardial infarction (MI). Results: A total of seven trials with 1,939 patients were included in the analysis. Compared with culprit-only revascularization, complete revascularization was associated with a non-significant reduction in the risk of mortality or MI (RR 0.69, 95% confidence interval (CI) 0.42–1.12, P = 0.14). Complete revascularization was associated with a reduced risk of major adverse cardiac events (MACE) (RR 0.61, 95% CI 0.45–0.81, P < 0.001), due to a significant reduction in urgent revascularization (RR 0.46, 95% CI 0.29–0.70, P < 0.001). The risk of major bleeding and contrast-induced nephropathy was similar with both approaches (RR 0.83, 95% CI 0.41–1.71, P = 0.62, and RR 0.94, 95% CI 0.42–2.12, P = 0.82). Conclusions: Complete revascularization of all significant coronary lesions at the time of primary PCI was associated with a reduction in the risk of MACE due to reduction in the risk of urgent revascularization. This approach appears to be safe, with no excess major bleeding, or contrast-induced nephropathy.

Original languageEnglish (US)
Pages (from-to)501-505
Number of pages5
JournalCatheterization and Cardiovascular Interventions
Volume88
Issue number4
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Keywords

  • meta-analysis
  • myocardial infarction
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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