title: Multi-vessel versus culprit-vessel and staged percutaneous coronary intervention in STEMI patients with multivessel disease: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) is preferred in patients with acute ST-elevation myocardial infarction (STEMI). In patients with acute STEMI with multivessel disease (MVD), the guidelines recommend culprit vessel PCI (CV-PCI) in the absence of hemodynamic instability. We performed a meta-analysis of all randomized controlled trials (RCTs) comparing multi-vessel PCI (MV-PCI) with CV-PCI or staged PCI (S-PCI) in patients with acute STEMI and MVD.
  
  
  METHODS
  PubMed, EMBASE and CENTRAL were searched for publications since inception to December 2013. Random effects model was used to compute summary effects.
  
  
  RESULTS
  Four RCTs (840 patients) were identified. MV-PCI compared to CV-PCI significantly reduced the risks of major adverse cardiac events (MACE)-a composite of MI, revascularization and all-cause mortality (RR: 0.46, 95% CI: 0.35-0.60, P<0.00001) by reducing the risks of MI (0.35, 0.17-0.71, P=0.004) and revascularization (0.35, 0.24-0.52, P<0.00001). The risk of all-cause mortality was not different (0.69, 0.39-1.21, P=0.19). S-PCI and MV-PCI had similar risks of MACE (0.96, 0.59-1.57, P=0.87), MI (0.60, 0.20-1.78, P=0.36), revascularization (0.86, 0.47-1.54, P=0.60) and all-cause mortality (1.50, 0.44-5.07, P=0.57).
  
  
  CONCLUSIONS
  MV-PCI compared to CV-PCI resulted in lower risks of MACE driven by lower MI and revascularization in patients with STEMI and multi-vessel disease.
authors.affiliation: Department of Medicine, LRGHealthcare, Laconia, NH. Electronic address: kdahal@lrgh.org.
authors.forename: Khagendra
authors.initials: K
authors.lastname: Dahal
authors.affiliation: Department of Medicine, Miriam Hospital, Brown University, Providence, RI.
authors.forename: Jharendra
authors.initials: J
authors.lastname: Rijal
authors.affiliation: Department of Medicine, LRGHealthcare, Laconia, NH.
authors.forename: Raju
authors.initials: R
authors.lastname: Panta
authors.affiliation: Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT.
authors.forename: Juyong
authors.initials: J
authors.lastname: Lee
authors.affiliation: Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT.
authors.forename: Michael
authors.initials: M
authors.lastname: Azrin
authors.affiliation: Department of Medicine, LRGHealthcare, Laconia, NH; Concord Cardiac Associates, Dartmouth Hitchcock Medical Center, Concord, NH.
authors.forename: Robert
authors.initials: R
authors.lastname: Lootens
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000097:blood; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Culprit vessel PCI; Multi-vessel PCI; Multivessel disease; STEMI