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. 2019 Summer;19(2):107-115.
doi: 10.31486/toj.18.0033.

Metaanalysis of Multivessel vs Culprit Artery Only Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction

Daniel C Garcia  1 , Alexandre M Benjo  1 , Christopher J White  1   2 , Rhanderson N Cardoso  3 , Francisco Y B Macedo  4 , Alan H Schob  5 , Georges E El-Hayek  6 , Girish N Nadkarni  7 , Emad F Aziz  6 , Rajan A G Patel  1   2
Affiliations

Metaanalysis of Multivessel vs Culprit Artery Only Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction

Daniel C Garcia et al. Ochsner J. 2019 Summer.

Abstract

Background: Primary percutaneous coronary intervention (PCI) is the most frequently used treatment modality for patients presenting with ST elevation myocardial infarction (STEMI). Current professional society guidelines recommend culprit artery only PCI. Recent evidence suggests the potential benefit of multivessel PCI among patients with STEMI that is not complicated by cardiogenic shock. Methods: We systematically searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for clinical studies of patients with STEMI, not complicated by cardiogenic shock, who underwent primary PCI between January 1966 and January 2018. We evaluated all-cause and cardiovascular mortality, reinfarction, and repeat revascularization among patients randomized to a multivessel PCI strategy compared to a culprit artery only PCI strategy. Results: Four randomized clinical trials with a total of 1,044 patients met the inclusion criteria. Five hundred and sixty-six patients underwent multivessel PCI, and 478 patients underwent culprit artery only PCI. Multivessel PCI reduced all the studied endpoints: total death, cardiac death, reinfarction, and repeat revascularization (all P values <0.05). Conclusion: To our knowledge, this is the largest metaanalysis of randomized controlled trials studying multivessel PCI vs culprit artery only PCI in STEMI patients without shock, among whom lesion severity was graded by angiography alone. We found that compared to culprit artery only PCI, the multivessel PCI strategy was beneficial in reducing all-cause and cardiovascular mortality, reinfarction, and the need for repeat revascularization.

Keywords: Coronary artery disease; ST elevation myocardial infarction; mortality; myocardial revascularization; percutaneous coronary intervention.

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Figures

Figure 1.
Figure 1.
Process of study selection for metaanalysis.
Figure 2.
Figure 2.
All-cause mortality. Multivessel percutaneous coronary intervention (PCI) strategy vs culprit artery only PCI strategy. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel.
Figure 3.
Figure 3.
Cardiac mortality. Multivessel percutaneous coronary intervention (PCI) strategy vs culprit artery only PCI strategy. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel.
Figure 4.
Figure 4.
Reinfarction. Multivessel percutaneous coronary intervention (PCI) strategy vs culprit artery only PCI strategy. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel.
Figure 5.
Figure 5.
Repeat revascularization. Multivessel percutaneous coronary intervention (PCI) strategy vs culprit artery only PCI strategy. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel.
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