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. 2020 Jun 13:29:100549.
doi: 10.1016/j.ijcha.2020.100549. eCollection 2020 Aug.

Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: A meta-analysis of randomized controlled trials

Gani Bajraktari  1   2   3 , Ibadete Bytyçi  1   2 , Michael Y Henein  1 , Fernando Alfonso  4 , Ali Ahmed  5 , Haki Jashari  1 , Deepak L Bhatt  6
Affiliations

Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: A meta-analysis of randomized controlled trials

Gani Bajraktari et al. Int J Cardiol Heart Vasc. .

Erratum in

Abstract

Background: The recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesions had a reduced risk of major adverse cardiac events (MACE), but not of cardiovascular or total mortality. The aim of this meta-analysis was to assess the efficacy of complete revascularization on cardiovascular or total mortality reduction using available randomized controlled trials (RCTs) including the COMPLETE trial, in hemodynamically stable STEMI patients with MVD.

Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n = 3420) vs. only culprit lesion (n = 3613) PCI for a median 27.7 months follow-up. Random effect risk ratios were used to estimate for efficacy and safety outcomes.

Results: Complete revascularization reduced the risk of MACE (10.4% vs.16.6%; RR = 0.59, 95% CI: 0.47 to 0.74, p < 0.0001), CV mortality (2.87% vs. 3.72%; RR = 0.73, 95% CI: 0.56 to 0.95, p = 0.02), reinfarction (5.1% vs. 7.1%; RR = 0.67, 95% CI: 0.52 to 0.86, p = 0.002), urgent revascularization (7.92% vs.17.4%; RR = 0.47, 95% CI: 0.30 to 0.73, p < 0.001), and CV hospitalization (8.68% vs.11.4%; RR = 0.65, 95% CI: 0.44to 0.96, p = 0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy.

Conclusion: The findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes.

Keywords: Complete revascularization; Coronary artery disease; Infarct artery only revascularization; Multi-vessel disease; ST-segment elevation myocardial infarction.

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Figures

Fig. 1
Fig. 1
PRISMA study selection flow chart.
Fig. 2
Fig. 2
Risk ratios of outcome with complete revascularization versus culprit-only revascularization; (a) MACE; (b) All-cause mortality; (c) CV mortality.
Fig. 3
Fig. 3
Risk ratios of outcome with complete revascularization versus culprit-only revascularization; (a) Reinfarction; (b) Urgent revascularization; (c) Hospitalization.
Fig. 4
Fig. 4
Risk ratios of safety procedure with complete revascularization versus culprit-only revascularization; (a) Stroke; (b) Major bleeding events; (c) Contrast induced nephropathy.
Fig. 5
Fig. 5
Risk ratios of outcome with complete revascularization versus culprit-only revascularization with the exclusion of COMPLETE trial 2019; (a) MACE; (b) All-cause mortality; (c) CV mortality.
See this image and copyright information in PMC

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