MULTIVESSEL VS CULPRIT VESSEL ONLY PERCUTANEOUS CORONARY INTERVENTION IN ST-ELEVATION MYOCARDIAL INFARCTION AND MULTIVESSEL CORONARY ARTERY DISEASE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Atti, Varunsiri; Narayanan, Mahesh Anantha; Garcia, Santiago; Sandoval, Yader; Brilakis, Emmanouil; Basir, Mir; Turagam, Mohit; Khandelwal, Akshay; Mena-Hurtado, Carlos I.; Mamas, Mamas A.; Kirtane, Ajay; Abbott, J.; Bhatt, Deepak; Velagapudi, Poonam

Abstract

Background
Approximately half of patients with ST-segment elevation acute myocardial infarction (STEMI) have multivessel coronary artery disease. Evidence from randomized controlled trials (RCT) comparing multivessel to culprit-only percutaneous coronary intervention (PCI) in STEMI has been controversial.

Methods
We performed comprehensive literature search for RCTs comparing multivessel PCI vs culprit-only PCI in clinicalTrials.gov, PubMed, Web of Science, EBSCO Services, Google Scholar from inception to September 15th 2019. Meta-analysis was performed using random - effects model to calculate risk ratio (RR) and 95% confidence interval (CI). Outcomes of interest included all-cause mortality, cardiovascular mortality, major adverse cardiac event (MACE) and major bleeding.

Results
We included 10 RCTs with 7,030 patients: 3,426 underwent multivessel PCI and 3,604 received culprit-only PCI. Compared with culprit-only PCI, multivessel PCI was associated with lower risk of MACE (RR: 0.54, 95%CI: 0.43 - 0.66), cardiovascular mortality (RR: 0.71, 95%CI: 0.50 - 1.00), reinfarction (RR: 0.69, 95%CI: 0.50 - 0.95) and repeat revascularization (RR: 0.34, 95%CI: 0.25 - 0.44) with no difference in all-cause mortality (RR: 0.85, 95%CI: 0.68 - 1.05), and major bleeding (RR: 0.92, 95%CI: 0.50 - 1.67).

Conclusion
Multivessel PCI was associated with lower risk of MACE, and cardiovascular mortality when compared with culprit-only PCI in STEMI without increase in risk of major bleeding.

Citation

Atti, V., Narayanan, M. A., Garcia, S., Sandoval, Y., Brilakis, E., Basir, M., Turagam, M., Khandelwal, A., Mena-Hurtado, C. I., Mamas, M. A., Kirtane, A., Abbott, J., Bhatt, D., & Velagapudi, P. MULTIVESSEL VS CULPRIT VESSEL ONLY PERCUTANEOUS CORONARY INTERVENTION IN ST-ELEVATION MYOCARDIAL INFARCTION AND MULTIVESSEL CORONARY ARTERY DISEASE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

• Presentation Conference Type: Conference Paper (published)
• Online Publication Date: Mar 16, 2020
• Publication Date: 2020-03
• Deposit Date: Jun 23, 2023
• Journal: Journal of the American College of Cardiology
• Print ISSN: 0735-1097
• Electronic ISSN: 1558-3597
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 75
• Issue: 11
• Pages: 171
• DOI: https://doi.org/10.1016/s0735-1097%2820%2930798-1
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://keele-repository.worktribe.com/output/504377