Network Meta-Analysis of Percutaneous Intervention-Based Revascularization Strategies for ST-Elevation Myocardial Infarction and Concomitant Multi-Vessel Disease

Fatima, Urooj; Khan, Safi U.; Akanbi, Olabisi; Girotra, Saket; Opoku-Asare, Isaac

doi:10.1016/j.carrev.2018.08.018

Cited by 6 publications

(3 citation statements)

References 44 publications

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“…Previous network meta-analysis conducted by Bangalore et al showed that immediate complete revascularization might be the preferred strategy in patients with STEMI and multivessel disease due to the significantly reduced risks of all-cause death or MI, all-cause death, MI and repeat revascularization, whereas staged complete revascularization only reduced the risk of repeat revascularization, but did not reduce the risk of all-cause death or MI compared with culprit-only PCI (16). Similarly, another network meta-analysis also indicated that immediate complete revascularization was associated with reduction in all-cause mortality and MI compared with culpritonly PCI, while no difference was found between staged complete revascularization and culprit-only PCI for all the endpoints except repeat revascularization (17). In contrast, some network meta-analyses concluded that staged rather than immediate complete revascularization was the best strategy for improving survival in patients with STEMI and multivessel disease (4,29).…”

Section: Discussionmentioning

confidence: 98%

“…Previous network meta-analyses showed that immediate complete revascularization might be the preferred strategy in this population due to the reduced risks of death or MI, death, MI and repeat revascularization. In contrast, staged complete revascularization did not significantly reduce death or MI compared with culprit-only PCI (16,17). Encouragingly, however, the Complete vs. Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI (COMPLETE) trial showed that staged PCI of non-culprit vessels reduced the 3-year risk of cardiovascular death or MI than culprit-only PCI (18).…”

Section: Introductionmentioning

confidence: 98%

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Optimal Revascularization Strategy for Patients With ST-segment Elevation Myocardial Infarction and Multivessel Disease: A Pairwise and Network Meta-Analysis

Cui

Yin

Zhu

et al. 2022

Front. Cardiovasc. Med.

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Background: The relative benefit of immediate complete revascularization, staged complete revascularization, and culprit-only percutaneous coronary intervention (PCI) remains unclear in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. The aim of this study was to compare the clinical outcomes of the 3 PCI strategies in this population.Methods: We followed a pre-specified protocol (PROSPERO number: CRD42020183801). A comprehensive search of the electronic databases including PubMed, EMBASE and Cochrane Library from inception through February 21, 2020 was conducted. Randomized trials evaluating the comparative efficacy and safety of at least 2 of the 3 PCI strategies were identified. The primary endpoint was the composite of cardiovascular mortality or myocardial infarction (MI) during the longest follow-up. Pairwise and network meta-analyses were performed with random-effects model.Results: Eleven trials including 6,942 patients were analyzed. Pairwise meta-analysis noted that immediate complete revascularization and staged complete revascularization were respectively associated with a 52 and 27% reduction in the risk of cardiovascular death or MI (relative risk [RR] 0.48, 95% confidence interval [CI] 0.32–0.73, I2 = 0%; and RR 0.73, 95% CI 0.61–0.88, I2 = 0%, respectively), compared with culprit-only PCI. The risk of cardiovascular death or MI was not statistically different in staged and immediate complete revascularization groups (RR 0.88, 95% CI 0.45–1.72, I2 = 0%). Network meta-analysis obtained almost similar results compared with pairwise meta-analysis, and immediate complete revascularization had a 77% probability of being the best strategy for reducing cardiovascular death or MI among the 3 PCI strategies.Conclusion: The current evidence suggests that both immediate and staged complete revascularization were associated with a reduction of cardiovascular death or MI compared with culprit-only PCI. Further trials are warranted to directly compare immediate vs. staged complete revascularization in this population.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO [CRD42020183801].

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

Optimal Revascularization Strategy for Patients With ST-segment Elevation Myocardial Infarction and Multivessel Disease: A Pairwise and Network Meta-Analysis

Cui

Yin

Zhu

et al. 2022

Front. Cardiovasc. Med.

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“…The SMILE trial involving NSTEMI patients with MVD showed the superiority of immediate non-IRA PCI compared to multistage PCI in terms of MACCE [22]. However, there are meta-analyses involving trials as well as observational studies showed superiority [23][24][25], non-inferiority [26,27], and inferiority [9] of immediate non-IRA PCI compared with staged PCI in regards to MACCE or all-cause mortality in AMI patients with MVD. A recently published trial, MULTISTARS AMI trial involving acute STEMI patients showed that immediate non-culprit coronary artery PCI is non-inferior compared with staged multivessel PCI in terms of the MACCE, all-cause death, MI, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure during the follow-up period.…”

Section: Introductionmentioning

confidence: 99%

Immediate vs. multistage revascularization of non-infarct coronary artery(-ies) in patients with hemodynamically stable multivessel disease acute myocardial infarction: a systematic review and meta-analysis

Oli,

Shrestha,

Dawadi

et al. 2024

Coronary Artery Disease

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Background Untreated multivessel disease (MVD) in acute myocardial infarction (AMI) has been linked to a higher risk of recurrent ischemia and death within one year . Current guidelines recommend percutaneous coronary intervention (PCI) for significant non-infarct artery (-ies) (non-IRA) stenosis in hemodynamically stable AMI patients with MVD, either during or after successful primary PCI, within 45-days. However, deciding the timing of revascularization for non-IRA in cases of MVD is uncertain. Methods This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023472652). Databases were searched for relevant articles published before 10 November 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4. Results Out of 640 studies evaluated, there were 13 RCTs with 5144 patients with AMI with MVD. The immediate non-IRA PCI is associated with a significantly lower occurrence of unplanned ischemia-driven PCI (OR 0.60; confidence interval [CI] 0.44–0.83) and target-vessel revascularization (OR 0.72; CI 0.53–0.97) . Although there is a favorable trend for major adverse cardiovascular and cerebrovascular events (MACCE), nonfatal AMI, cerebrovascular events, and major bleeding in the immediate non-culprit artery (-ies) PCI, those were statistically non-significant. Similarly, all-cause mortality, cardiovascular mortality, stent thrombosis, and acute renal insufficiency did not show significant differences between two groups. Conclusion Among hemodynamically stable patients with multivessel AMI, the immediate PCI strategy was superior to the multistage PCI strategy for the unplanned ischemia-driven PCI and target-vessel revascularization while odds are favorable in terms of MACCE, nonfatal AMI, cerebrovascular events, and major bleeding at longest follow-up.

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Complete Revascularization in Patients With STEMI and Multi-Vessel Disease: A Meta-Analysis of Randomized Controlled Trials

Al‐Abdouh

Barbarawi

Bizanti

et al. 2020

Cardiovascular Revascularization Medicine

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Network Meta-Analysis of Percutaneous Intervention-Based Revascularization Strategies for ST-Elevation Myocardial Infarction and Concomitant Multi-Vessel Disease

Abstract: In this NMA, CR-I was associated with reduction in all-cause mortality and re- infarction compared with IRA.

Cited by 6 publications

References 44 publications

Optimal Revascularization Strategy for Patients With ST-segment Elevation Myocardial Infarction and Multivessel Disease: A Pairwise and Network Meta-Analysis

Optimal Revascularization Strategy for Patients With ST-segment Elevation Myocardial Infarction and Multivessel Disease: A Pairwise and Network Meta-Analysis

Immediate vs. multistage revascularization of non-infarct coronary artery(-ies) in patients with hemodynamically stable multivessel disease acute myocardial infarction: a systematic review and meta-analysis

Complete Revascularization in Patients With STEMI and Multi-Vessel Disease: A Meta-Analysis of Randomized Controlled Trials

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