Abstract 4695: Complete Revascularization versus Culprit-only Revascularization in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A Meta-Analysis
Background: The ACC/AHA guidelines for management of patients with ST-elevation myocardial infarction (STEMI) recommend culprit artery only percutaneous coronary intervention (PCI) based on safety concerns during non infarct related artery PCI. However, the data to support this is scant, specially in this era with better adjunctive pharmacotherapy and improvement in stent technology.
Methods: PUBMED/EMBASE/CENTRAL search for studies evaluating complete revascularization vs. culprit artery only revascularization in patients with STEMI and multivessel coronary artery disease (CAD). The complete revascularization strategy had to be performed at the time of culprit artery revascularization. Studies in which complete revascularization was obtained through staged PCI were excluded. 30 day and long term outcomes were compared between the two groups.
Results: Among 10 studies which evaluated 5226 patients presenting with STEMI, complete revascularization was achieved in 1406 (27%) patients while the remaining 3820 (63%) patients underwent culprit only PCI during index hospitalization. Complete revascularization was not associated with any increase in the risk of either 30 day or long term cardiovascular outcomes (Table⇓) and was associated with a trend towards decrease in length of stay (4.8 +/− 3.5 vs. 7.5 +/− 3.7; p=0.05) when compared to culprit artery only revascularization strategy.
Conclusions: In patients presenting with STEMI and multivessel CAD, a strategy of complete revascularization appears to be safe compared to culprit artery only revascularization strategy. These findings support the need for a randomized trial to evaluate revascularization strategies in patients presenting with STEMI and multivessel CAD.