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. 2022 Mar 10:13:20406223221078088.
doi: 10.1177/20406223221078088. eCollection 2022.

The optimal percutaneous coronary intervention strategy for patients with ST-segment elevation myocardial infarction and multivessel disease: a pairwise and network meta-analysis

Meng-Jin Hu  1 , Jiang-Shan Tan  1 , Wen-Yang Jiang  1 , Xiao-Jin Gao  1 , Yue-Jin Yang  2
Affiliations

The optimal percutaneous coronary intervention strategy for patients with ST-segment elevation myocardial infarction and multivessel disease: a pairwise and network meta-analysis

Meng-Jin Hu et al. Ther Adv Chronic Dis. .

Abstract

Objective: To investigate the optimal percutaneous coronary intervention (PCI) strategy in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease.

Methods: Trials that randomized patients with STEMI and multivessel coronary artery disease to immediate multivessel PCI, staged multivessel PCI, or culprit-only PCI and prospective observational studies that investigated all-cause death were included. Random effect risk ratio (RR) and 95% confidence interval (CI) were calculated.

Results: A total of 13 randomized trials with 7627 patients and 21 prospective observational studies with 60311 patients were included. In the pairwise and network meta-analysis based on randomized trials, immediate or staged multivessel PCI was associated with a lower risk of long-term major adverse cardiac events (MACE; RR: 0.58; 95% CI: 0.45 to 0.74) than culprit-only PCI, which was mainly due to lower risks of myocardial infarction (RR: 0.67; 95% CI: 0.51 to 0.88) and revascularization (RR: 0.38; 95% CI: 0.28 to 0.51), without any significant difference in all-cause death (RR: 0.85; 95% CI: 0.69 to 1.04; I 2 = 0.0%). However, short-term outcomes were deficient in randomized trials. The results from real-world prospective observational studies suggested that staged multivessel PCI reduced long-term all-cause death (RR: 0.53; 95% CI: 0.39 to 0.71; I 2 = 15.6%), whereas immediate multivessel PCI increased short-term all-cause death (RR: 1.58; 95% CI: 1.22 to 2.05; I 2 = 43.8%) relative to culprit-only PCI.

Conclusion: For patients in randomized trials, multivessel PCI in an immediate or staged procedure was preferred due to improvements in long-term outcomes. As a supplement, the results in real-world patients derived from prospective observational studies suggested that staged multivessel PCI was superior to immediate multivessel PCI. Therefore, staged multivessel PCI may be the optimal PCI strategy for patients with STEMI and multivessel coronary artery disease.

Keywords: ST-segment elevation myocardial infarction; multivessel disease; multivessel revascularization; network meta-analysis; percutaneous coronary intervention.

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Conflict of interest statement

Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow of the study search. CTO, chronic total occlusion; PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses.
Figure 2.
Figure 2.
Network evidence and risk of bias of included studies. Network evidence plot for primary outcome of randomized trials (a–d), all-cause death of prospective observational studies (e and f), and risk of bias of included randomized trials (g).
Figure 3.
Figure 3.
Pairwise meta-analysis of long-term all-cause death based on randomized trials.
Figure 4.
Figure 4.
Pairwise meta-analysis of all-cause death based on prospective observational studies. (a) Immediate MV-PCI vs Culprit-only PCI, (b) Staged MV-PCI vs Culprit-only PCI, and (c) Immediate MV-PCI vs Staged MV-PCI.
Figure 5.
Figure 5.
Results of the TSA for the risks of long-term primary outcomes based on randomized trials. (a) MACE, (b) All-cause death, (c) Myocardial infarction, and (d) Revascularization. TSA, trial sequential analysis.
Figure 6.
Figure 6.
Forest plot and cumulative probability rankings for the network meta-analysis. Forest plot for the network meta-analysis (a) and cumulative probability rankings (b–e) for long-term primary outcomes based on randomized trials.
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