Infarct related artery only versus complete revascularization in ST-segment elevation myocardial infarction and multi vessel disease: a meta-analysis

Abstract

(ACCF/AHA) focused update on primary percutaneous coronary intervention (PCI) for patients with STsegment elevation myocardial infarction (STEMI) only gives a class II b (weak) indication for non-infarct artery intervention at the time of primary PCI. Recent randomized controlled trials, however, suggest strong evidence supporting complete revascularization.Methods: A systematic search was conducted in PUBMED, MEDLINE, EMBASE and Cochrane central register for randomized controlled trials comparing complete versus infarct artery (IRA) only revascularization in patients with STEMI. A meta-analysis was performed using the data extracted from each study. Summary risk ratios (RR) and 95% confidence intervals (CI) were calculated for five outcomes.Results: Six trials fulfilled the inclusion criteria yielding 1,792 patients. Follow up ranged from 6 months to 2.5 years. The incidence of major adverse cardiac events (MACE) was significantly lower in the complete revascularization group compared to the IRA only revascularization (13.8% vs. 25.1%, RR =0.51; 95% CI: 0.41-0.64, P<0.00001). It was attributed to significantly lower repeat revascularization rate in the complete revascularization group (8.2% vs. 18.9%, RR =0.41; 95% CI: 0.31-0.54, P<0.00001). This meta-analysis also showed a significant reduction in cardiovascular mortality (2.0% vs. 4.6%, RR =0.42; 95% CI: 0.24-0.74; P=0.003), non-fatal myocardial infarction (4.37% vs. 5.76%, RR =0.64; 95% CI: 0.34-1.20; P=0.16) and allcause mortality rates [(4.6% vs. 6%), RR =0.75; 95% CI: 0.49-1.14, P=0.17] in the complete revascularization group, compared to the IRA revascularization group. Conclusions:In patients who present with STEMI, complete revascularization is associated with lower rates of MACE and cardiovascular deaths as compared to revascularization of the IRA alone. Even though the outcomes of all-cause mortality and nonfatal re-infarction rates were lower in the complete revascularization group, they were not significant.

Gender difference with the use of percutaneous left ventricular assist device in patients undergoing complex high-risk percutaneous coronary intervention: From pVAD Working Group

“…Recent metaanalysis emphasizes performing single setting complete revascularization in acute coronary syndrome. 24,25 As was seen in our patient population, both genders garnered better outcomes of mortality, MACEs and overall complications when complete revascularization was performed, although our patient population was not a STEMI cohort but did include non-STEMI and acute coronary syndrome patients. Traditionally CABG has been demonstrated to have improved long term benefits over PCI in this CHIP population, although only in coronary artery bypass grafting (CABG) eligible patients.…”

Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

“…Both females and males, had better outcomes in terms of mortality, MACE and overall complications when complete revascularization was performed. [21][22][23][24] In addition, 90-day follow-up data from the PROTECT II trial showed a significant decrease in major adverse 30-day survival rates Secondary outcomes such as major adverse cardiac events, dialysis requirement, bleeding within 72 hr, blood transfusion, dysrhythmia were similar in both cohorts. 25 Complete revascularization is often achieved with CABG surgery and has been shown to be associated with long-term mortality benefits.…”

Serum parameters and severity of coronary artery disease in patients with acute coronary syndrome

“…gold standard treatment, its outcome may not be much different from other treatment modalities such as stents with percutaneous coronary intervention (PCI) while all treatment modalities are associated with a considerable risk of mortality and recurrence of MI (7,8).…”