Early Complete Revascularization in Hemodynamically Stable Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease

Fortuni, Federico; Angelini, Filippo; Leonardi, Sergio; D’Ascenzo, Fabrizio; Ferlini, Marco; Rolando, Marco; Raisaro, A; Visconti, Luigi Oltrona; Ferrario, Maurizio; Gnecchi, Massimiliano; Ferrari, Gaetano Maria De

doi:10.1016/j.cjca.2019.03.006

Cited by 9 publications

(3 citation statements)

References 30 publications

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“…[1][2][3][4][5][6][7][8][9][10][11] To overcome these limitations several meta-analyses have been carried out. 12,13 However, they displayed several limitations and did not achieve an adequate sample size for reliable estimation in cardiovascular death. Recently, the Complete vs. Culprit-only Revascularization to Treat Multi-vessel Disease After Early Percutaneous coronary intervention for STEMI (COMPLETE) study has been published.…”

Section: Introductionmentioning

confidence: 99%

Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

Pavasini

Biscaglia

Barbato

et al. 2019

European Heart Journal

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Aims The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and results Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39–0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36–150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55–0.84, I2 = 0% and HR 0.29, 95% CI 0.22–0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37–55) for MI and 8 (95% CI 5–13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56–1.16, I2 = 27%) was not affected by the revascularization strategy. Conclusion In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

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Section: Introductionmentioning

confidence: 99%

Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

Pavasini

Biscaglia

Barbato

et al. 2019

European Heart Journal

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“…Postoperative outcomes, including the left ventricular ejection fraction (LVEF) at discharge and various complications like cardiogenic shock, stroke, myocardial infarction (MI), arrhythmias, all-cause mortality, and ST-segment resolution, displayed some variability between the two groups. However, statistical significance varied across these parameters (Fortuni et al, 2019). Looking at the 6-month outcomes, the occurrence of angina, repeat hospitalization for cardiovascular events, MI, major adverse cardiovascular events (MACE), and mortality differed between groups.…”

Section: Discussionmentioning

confidence: 98%

Comparative Analysis of Staged Versus Index Procedure Complete Revascularization in St-Elevation Myocardial Infarction

SHAH,

KHAN

2024

Biol Clin Sci Res J

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ST-elevation myocardial infarction (STEMI) is a critical condition that necessitates quick and efficient revascularization techniques. Recently, there has been a discussion on the best method for revascularization staged versus index procedure complete revascularization. The study compares the clinical outcomes of staged versus index procedure complete revascularization in ST-elevation myocardial infarction. This study is a prospective comparative analysis conducted at Ayub Teaching Hospital, Abbottabad. The patients were divided into two groups, with 40 participants in each group. Demographic data that included Smoking history, Diabetes mellitus, Dyslipidemia, Previous MI, and (LVEF) was recorded. Intraoperative and postoperative outcomes at 72 hours and six months were recorded. The quality of life was also assessed using SF-36 16. Data was entered and analyzed using SPSS (Statistical Package for the Social Sciences) version 24. P-values of ≤0.05 will be considered statistically significant. These findings suggest that in Group A, the frequency of "No reflow" (1 case) and "Abrupt closure" (0 instances) p=0.02) compared to Group B, where "No reflow" was observed in 2 cases and "Abrupt closure" in 1 case, (and (p=0.01), the investigation into post-operative outcomes, revealed no statistically significant differences between the two groups. P values ranged from 0.31 to 0.45, indicating comparable outcomes. After six months post-surgery, Group A demonstrated significantly better outcomes across various health-related domains than Group B, as indicated by the SF-36 questionnaire. In conclusion, index complete vascularization holds a distinct advantage over staged procedures. The observed differences across various health indicators highlight the potential clinical significance of prioritizing complete revascularization during the initial intervention.

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“…Compared with prior meta-analysis studies [13,[18][19][20][21] in the same field, for the first time our study evaluated the effects of important factors relevant with patient characteristics on the efficacy of complete revascularization vs culprit-only revascularization for treatment of STEMI with multivessel disease by conducting subgroup meta-analysis stratified by 5 factors of interest (i.e., sex, age, history of diabetes, ECG infarct location, and the number of arteries with stenosis) and conducting meta-regression analysis with the 5 factors as independent variables. Accordingly, 3 main findings were produced as follows.…”

Section: Discussionmentioning

confidence: 99%

Effects of patient characteristics on the efficacy of complete revascularization for treatment of ST-segment elevation myocardial infarction with multivessel disease

Li¹,

Qiu²,

Liu

et al. 2021

Medicine

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Background: Several randomized controlled trials (RCTs) have evaluated the efficacy of complete vs culprit-only revascularization for treatment of ST-segment elevation myocardial infarction (STEMI) with multivessel disease. However, the efficacy of complete revascularization vs culprit-only revascularization in some STEMI patient subgroups remains unclear. Methods: We searched PubMed and Embase for related RCTs from the start date of databases to January 3, 2020. The endpoint assessed in this meta-analysis was major adverse cardiac events (MACE). Random-effects meta-analysis was conducted stratified by each of the 5 factors of interest (i.e., sex, age, history of diabetes, ECG infarct location, and the number of arteries with stenosis) to estimate pooled hazard ratio and 95% confidence interval. Random-effects meta-regression was conducted to assess subgroup differences. We examined publication bias by drawing funnel plots and performing Egger test. This meta-analysis is reported according to the PRISMA statement. Results: Six RCTs were included for pooled analysis. Compared with culprit-only revascularization, complete revascularization significantly reduced the risk of MACE (hazard ratio 0.48, 95% confidence interval 0.42–0.55; I 2 = 0%; P for relative effect < .001). This significant reduction in the risk of MACE exhibited by complete revascularization was observed in most of the subgroups of interest. All of the subgroup effects based on the 5 factors of interest were not statistically significant ( P subgroup ranged from 0.198 to 0.556). Publication bias was not suggested by funnel plots and Egger test. Conclusions: Compared with culprit-only revascularization, complete revascularization significantly reduces the MACE risk in patients with STEMI and multivessel disease, which is independent of sex, age, history of diabetes, ECG infarct location, and the number of arteries with stenosis.

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Early Complete Revascularization in Hemodynamically Stable Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease

Cited by 9 publications

References 30 publications

Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

Comparative Analysis of Staged Versus Index Procedure Complete Revascularization in St-Elevation Myocardial Infarction

Effects of patient characteristics on the efficacy of complete revascularization for treatment of ST-segment elevation myocardial infarction with multivessel disease

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