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. 2015 Apr;23(4):224-31.
doi: 10.1007/s12471-015-0674-9.

Multivessel revascularisation versus infarct-related artery only revascularisation during the index primary PCI in STEMI patients with multivessel disease: a meta-analysis

S Rasoul  1 , V van Ommen, J Vainer, M Ilhan, L Veenstra, R Erdem, L A W Ruiters, R Theunissen, J C A Hoorntje
Affiliations

Multivessel revascularisation versus infarct-related artery only revascularisation during the index primary PCI in STEMI patients with multivessel disease: a meta-analysis

S Rasoul et al. Neth Heart J. 2015 Apr.

Abstract

Background: There are controversial data regarding infarct-related artery only (IRA-PCI) revascularisation versus multivessel revascularisation (MV-PCI) in ST-elevation myocardial infarction (STEMI) patients with multivessel disease undergoing primary percutaneous coronary intervention (PCI). We performed a meta-analysis comparing outcome in same stage MV-PCI versus IRA-PCI in STEMI patients with multivessel disease.

Methods: Systematic searches of studies comparing MV-PCI with IRA-PCI in the MEDLINE and the Cochrane Database of systematic reviews were conducted. A meta-analysis was performed of all available studies. Primary outcome was all-cause mortality. Secondary endpoints were re-infarction, revascularisation, bleeding and major adverse cardiac events (MACE).

Results: A total of 15 studies were identified with a total number of 35,975 patients. Mortality rate was significantly higher in the MV-PCI group compared with the IRA-PCI group, odds ratio (OR): 1.64 (1.46-1.85). Both the incidence of re-infarction and re-PCI were significantly lower in the MV-PCI group compared with the IRA-PCI group: OR 0.54 (0.34-0.88) and OR 0.67 (0.48-0.93), respectively. Bleeding complications occurred more often in the MV-PCI group as compared with the IRA-PCI group: OR 1.24 (1.08-1.42). Rates of MACE were comparable between the two groups.

Conclusions: MV-PCI during the index of primary PCI in STEMI patients is associated with a higher mortality rate, a higher risk of bleeding complications, but lower risk of re-intervention and re-infarction and comparable rates of MACE.

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Figures

Fig. 1
Fig. 1
Forest plot of all-cause mortality
Fig. 2
Fig. 2
a Forest plot of re-infarction. b Forest plot of re-percutaneous coronary intervention
Fig. 3
Fig. 3
Forest plot of bleeding (major and minor)
Fig. 4
Fig. 4
Forest plot of major adverse cardiac events (death, re-infarction and re-percutaneous coronary intervention)
See this image and copyright information in PMC

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