Survival After Varying Revascularization Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

Abstract

The present systematic review and meta-analysis supports the hypothesis that in patients with MV-CAD presenting with STEMI undergoing primary PCI, a staged multivessel revascularization strategy may improve early and late survival.

Complete versus culprit only revascularization in ST-elevation myocardial infarction—a perspective on recent trials and recommendations

“…This showed that immediate complete revascularization might be more superior compared to staged revascularization. This finding seems to be opposite of what was found in other metaanalyses (40,44) and the few observational studies (45,46).…”

“…This study showed that MV-PCI during index procedure was associated with an increased all-cause mortality [hazard ratio (HR) 4.1, 95% CI: 1.93-8.86, P<0.0001] and cardiovascular mortality (HR 3.41, 95% CI: 1.35-7.27, P=0.005) compared to the staged MV-PCI (45). Similarly, a meta-analysis by Tarantini et al (40) revealed that staged revascularization was associated with short-and long-term survival compared with both immediate complete revascularization and culprit-only revascularization. In separate meta-analysis by Li et al (44) which compared staged revascularization and immediate complete revascularization head-to-head, the former seemed to be a better strategy.…”

“…They have discordant results, which was largely driven by the inclusion of different variety of trials to conduct the meta-analyses and by the fact that none of the RCTs were adequately powered for the hard outcomes of death and MI. Overall, MV-PCI seems to be associated with lower risk of MACE, repeat revascularization, but with a similar risks of recurrent MI and mortality compared to culprit-only revascularization (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44).…”

Impact of stent generation on 2‐year clinical outcomes in ST‐segment elevation myocardial infarction patients with multivessel disease who underwent culprit‐only or multivessel percutaneous coronary intervention

“…Even though we had published the data concerning 1‐year clinical outcomes between the same generation stents in patients with STEMI with MVD, the comparative studies that focused on the long‐term clinical outcomes of different generations of stents in STEMI patients with MVD after C‐PCI or M‐PCI are rare. M‐PCI carries the risk of procedural complications during PCI of nonculprit lesions, such as abrupt vessel closure and stent thrombosis, may be increased in the prothrombotic and proinflammatory state that characterizes STEMI compared with C‐PCI . The main differences between C‐PCI and M‐PCI are total procedure time, time interval between index PCI and staged PCI, and the possibility for the exposure to those unfavorable situations.…”

Staged versus index procedure complete revascularization in ST‐elevation myocardial infarction: A meta‐analysis

“…While the American College of Cardiology (ACC)/American Heart Association (AHA) upgraded the recommendation for non‐IRA PCI at the time of index procedure or as staged procedure from III to IIb, giving an equal level of recommendation to both index procedure and staged revascularization, the European Society of Cardiology (ESC) gives a IIa recommendation for staged revascularization of non‐IRA and IIb for index procedure revascularization . A recent metanalysis of observational and randomized controlled studies by Tarantini et al and a British Columbia Cardiac Registry study have both demonstrated lower mortality and repeat revascularization with staged multivessel intervention (MVI‐S) compared to index procedure multivessel intervention (MVI‐I). The goal of the current study was to compare any staged, but complete revascularization with complete revascularization at the time of the index STEMI PCI procedure in patients with multivessel CAD presenting with STEMI.…”