Complete revascularization for patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: a meta-analysis of randomized trials

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Bajraktari, GaniUmeå universitet,Avdelningen för medicin,Clinic of Cardiology, University Clinical Centre of Kosova; Department of Internal Medicine, Medical Faculty, University of Prishtina, Prishtina, Republic of Kosovo (author)

Complete revascularization for patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease : a meta-analysis of randomized trials

Article/chapterEnglish2018

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Lippincott Williams & Wilkins,2018
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LIBRIS-ID:oai:DiVA.org:umu-150707
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-150707URI
https://doi.org/10.1097/MCA.0000000000000602DOI

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Language:English
Summary in:English

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Introduction: Despite the recent findings in randomized clinical trials (RCTs) with limited sample sizes and the updates in clinical guidelines, the current available data for the complete revascularization (CR) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) at the time of primary percutaneous coronary intervention (PCI) are still contradictory.Aim: The aim of this meta-analysis of the existing RCTs was to assess the efficacy of the CR versus revascularization of infarct-related artery (IRA) only during primary PCI in patients with STEMI and multivessel disease (MVD).Patients and methods: We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases aiming to find RCTs for patients with STEMI and MVD which compared CR with IRA-only. Random effect risk ratios (RRs) were calculated for efficacy and safety outcomes.Results: Ten RCTs with 3291 patients were included. The median follow-up duration was 17.5 months. Major adverse cardiac events (RR=0.57; 0.43-0.76; P<0.0001), cardiac mortality (RR=0.52; 0.31-0.87; P=0.014), and repeat revascularization (RR=0.50; 0.30-0.84; P=0.009) were lower in CR compared with IRA-only strategies. However, there was no significant difference in the risk of all-cause mortality, recurrent nonfatal myocardial infarction, stroke, major bleeding events, and contrast-induced nephropathy.Conclusion: For patients with STEMI and MVD undergoing primary PCI, the current evidence suggests that the risk of major adverse cardiac events, repeat revascularization, and cardiac death is reduced by CR. However, the risk for all-cause mortality and PCI-related complications is not different from the isolated culprit lesion-only treatment. Although these findings support the cardiac mortality and safety benefit of CR in stable STEMI, further large trials are required to provide better guidance for optimum management of such patients.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
complete revascularization
coronary artery disease
infarct-related artery-only revascularization
multivessel disease
ST-segment elevation myocardial infarction

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Jashari, HakiUmeå universitet,Avdelningen för medicin,Clinic of Cardiology, University Clinical Centre of Kosova(Swepub:umu)haja0040 (author)
Ibrahimi, PranveraUmeå universitet,Avdelningen för medicin,Clinic of Cardiology, University Clinical Centre of Kosova(Swepub:umu)prib0001 (author)
Alfonso, Fernando (author)
Jashari, FisnikUmeå universitet,Avdelningen för medicin,Department of Internal Medicine, Medical Faculty, University of Prishtina, Prishtina, Republic of Kosovo(Swepub:umu)fija0001 (author)
Ndrepepa, Gjin (author)
Elezi, Shpend (author)
Henein, Michael Y.Umeå universitet,Avdelningen för medicin,St George University, London, UK(Swepub:umu)mihe0015 (author)
Umeå universitetAvdelningen för medicin (creator_code:org_t)

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In:Coronary Artery Disease: Lippincott Williams & Wilkins29:3, s. 204-2150954-69281473-5830

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