TY - JOUR
T1 - Complete Versus Culprit-Only Revascularization for Patients With Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention
T2 - An Updated Meta-Analysis of Randomized Trials
AU - Elgendy, Islam Y.
AU - Wen, Xuerong
AU - Mahmoud, Ahmed
AU - Bavry, Anthony A.
N1 - Publisher Copyright:
© 2015 Wiley Periodicals, Inc.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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.
AB - 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.
KW - meta-analysis
KW - myocardial infarction
KW - percutaneous coronary intervention
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U2 - 10.1002/ccd.26322
DO - 10.1002/ccd.26322
M3 - Article
C2 - 26524970
AN - SCOPUS:84949204547
SN - 1522-1946
VL - 88
SP - 501
EP - 505
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -