Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: Systematic review and meta-analysis of randomized clinical trials Articles uri icon

authors

  • Pavasini, Rita
  • Biscaglia, Simone
  • Barbato, Emanuele
  • Tebaldi, Matteo
  • Dudek, Dariusz
  • Escaned, Javier
  • Casella, Gianni
  • Santarelli, Andrea
  • Guiducci, Vincenzo
  • GUTIERREZ IBAÑES, ENRIQUE
  • Di Pasquale, Giuseppe
  • Politi, Luigi
  • Saglietto, Andrea
  • D'Ascenzo, Fabrizio
  • Campo, Gianluca

publication date

  • November 2020

start page

  • 4103

end page

  • 4110

issue

  • 42

volume

  • 41

International Standard Serial Number (ISSN)

  • 0195-668X

Electronic International Standard Serial Number (EISSN)

  • 1522-9645

abstract

  • Aims: The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and results: Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39-0.97, I2 - 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36-150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55-0.84, I2 - 0% and HR 0.29, 95% CI 0.22-0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37-55) for MI and 8 (95% CI 5-13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56-1.16, I2 - 27%) was not affected by the revascularization strategy. Conclusion: In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

keywords

  • complete revascularization; culprit-only revascularization; st-segment elevation myocardial infarction; mortality