Abstract 15079: Complete Revascularization for Multivessel Disease ST Elevation Myocardial Infarction: Insights From an Updated Meta-Analysis
Introduction: Multivessel Disease is commonly seen in ST Elevation Myocardial Infarction (STEMI). Current guidelines recommend primary percutaneous coronary intervention (PCI) on only the culprit vessel , unless the patient is hemodynamically unstable. Recent trials have reported significant benefit on cardiovascular endpoints with complete revascularization of vessels during STEMI. The purpose of this meta analysis was to assess the benefit of complete revascularization (either single setting or staged PCI) compared to culprit only PCI in STEMI patients with multivessel disease.
Methods: We searched PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science ,CINAHL databases and presentations at major cardiovascular scientific sessions from inception through June 5th, 2015. Randomized Trials comparing complete revascularization strategies (single-setting PCI or staged PCI) and culprit-only PCI were included. The primary outcome of interest was major adverse cardiovascular events (MACE) defined as a composite of all-cause mortality, new myocardial infarction (MI) and repeat revascularization.
Results: Seven trials enrolling a total of 2006 patients were included in the final analysis. Complete revascularization (single-setting PCI + staged PCI) was associated with a significant reduction in MACE, when compared to culprit only PCI [OR 0.52; 95 % CI 0.32 to 0.85; P = 0.009]. However, there was no significant difference in all cause mortality [OR 0.75; 95 % CI 0.51 to 1.12] or recurrent MI [OR 0.74;95 % CI 0.4 to 1.39] with complete revascularization.
Conclusion: In patients with STEMI and multivessel disease, complete revascularization is associated with a significant reduction in major adverse cardiovascular outcomes, driven primarily by a reduction in repeat revascularization, with no evidence of significant difference in all cause mortality or recurrent MI when compared to culprit only PCI.
Author Disclosures: A. Kundu: None. P. Sardar: None. S. Chatterjee: None. J. Giri: None. D. Mukherjee: None.
- © 2015 by American Heart Association, Inc.