title: Management of multivessel coronary disease in STEMI patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Appropriate management for patients with multivessel coronary disease presenting with ST segment Elevation Myocardial Infarction (STEMI) remains to be defined.
  
  
  RESULTS
  Medline and Cochrane Library were searched for randomized controlled trials (RCTs) or observational studies adjusted with multivariate analysis, reporting about STEMI patients with multivessel coronary disease treated with either a culprit only or complete revascularization strategy, excluding patients in cardiogenic shock. Prespecified analysis was performed according to the strategy of complete revascularization, either during the same procedure of primary percutaneous coronary intervention (PCI) or during the index hospitalization. MACE (a composite and mutually exclusive end point of death or myocardial infarction or revascularization) at follow-up of at least one year was the primary end point. 9 studies with 4686 patients compared culprit only versus complete PCI performed during the primary PCI. Rates of MACE did not differ at 90 days (OR 0.70 [0.38, 1.27], I(2)=0%) or at 1 year (1-2.5) (OR 0.70 [0.47, 1.03], I(2)=0%). No significant difference was found for the components of the primary outcome, apart from a reduction in repeated revascularization for patients undergoing complete PCI during the STEMI procedure (OR 0.62 [0.39, 0.98], I(2)=0%). 6 studies (1 RCT) with 5855 patients compared culprit only lesions versus complete PCI performed during index hospitalization. 90 day risk of MACE did not differ nor 1 year (1-2.5) MACE (OR 0.86 [0.62, 1.08], I(2)=0%), with a similar reduction in repeated revascularization (0.60 [0.40, 0.90], I(2)=0%).
  
  
  CONCLUSIONS
  Complete revascularization performed during primary PCI or index hospitalizations for patients presenting with STEMI appears safe at short term follow-up and offers a reduction in repeated revascularization at one year.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy. Electronic address: fabrizio.dascenzo@gmail.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Quadri
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Montefusco
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
authors.forename: Salma
authors.initials: S
authors.lastname: Taha
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Colaci
authors.affiliation: Nanjing Medical University, Nanjing, China.
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D018570:Risk Assessment
keywords: Complete revascularization; Multivessel disease; STEMI