Complete versus culprit only revascularization in acute ST elevation myocardial infarction: a meta-analysis

Abstract

Background: Current guidelines recommend against the revascularization of noninfarct related artery (complete revascularization [CR]) in patients with ST elevation myocardial infarction (STEMI) and no hemodynamic compromise, though level of evidence is C.

Aim: Our aim was to examine the available evidence to determine any advantage of CR over culprit only revascularization (COR).

Methods: We systematically searched medline using key words-"culprit coronary revascularization," "complete revascularization myocardial infarction," and "multivessel STEMI" for studies reporting outcomes after COR versus CR during primary procedure or index hospitalization published in English language and indexed before February 2010. A random effect or fixed effect meta-analysis, as applicable, was performed using RevMan 5 (Cochrane Center, Denmark).

Results: Nine eligible nonrandomized studies amounting to 4,530 patients in CR and 27,323 patients in COR group were included. In addition, two small randomized trials were reviewed and included in secondary analysis. Majority of patients were hemodynamically stable. Major adverse cardiovascular events (Odds ratio [OR] = 0.95, 95% CI 0.47-1.90) and long term mortality (OR = 1.10, 95% CI 0.76-1.59) were similar. The marginal increased odds of in-hospital mortality was derived from a single study with no difference found after sensitivity and cumulative analysis (OR = 1.21 95% CI 0.85-1.73).

Conclusion: Current analysis of heterogeneous studies did not reveal any benefit of CR over COR in patients with STEMI. However, also provide no conclusive evidence of increased in hospital mortality after CR. A randomized trial is needed to confirm these findings and recognize any subgroup which might benefit from CR.