title: Target-vessel versus multivessel revascularisation in ST-elevation myocardial infarction: a meta-analysis of randomised trials.
abstract: BACKGROUND
  In acute ST-segment elevation myocardial infarction (STEMI), coronary reperfusion with percutaneous coronary intervention (PCI) to treat the culprit lesion responsible for infarction improves clinical outcomes in nearly all patients. The concurrent treatment of non-infarct vessels with significant stenoses during initial angiography remains an area of controversy.
  
  
  METHODS
  A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane Library, Google Scholar, Science Direct, and Web of Science. Original data were abstracted from each study and used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI).
  
  
  RESULTS
  Only four randomised trials comprising 775 patients met full criteria for analysis. The incidence of non-fatal MI (3.25% vs 8.51%, OR: 0.376, 95% CI: 0.192-0.763), refractory angina (4.01% vs 9.57%, OR: 0.400, 95% CI: 0.241-0.741) and repeat revascularisation (10.52% vs 24.20%, OR: 0.336, 95% CI: 0.202-0.661) was lower in the multivessel revascularisation cohort. Death from cardiac causes or refractory angina or non-fatal MI (11.78% vs 28.86%, OR: 0.336, 95% CI: 0.223-0.505) and death from cardiac causes or non-fatal MI (5.26% vs 12.76%, OR: 0.420, 95% CI: 0.245-0.722) were significantly lower in the multivessel revascularisation cohort. The Median Contrast Volume and Procedure Length were similar in both cohorts.
  
  
  CONCLUSIONS
  In patients with acute STEMI who undergo primary PCI, a strategy of treatment of significant non-infarct stenosis (preventive PCI) in addition to the culprit lesion responsible for infarction may result in improved cardiovascular outcomes and reduced overall mortality; however there is insufficient data to fully validate this from currently published literature.
authors.affiliation: Prince of Wales Hospital, University of New South Wales, Sydney.
authors.forename: Kiran
authors.initials: K
authors.lastname: Sarathy
authors.affiliation: Prince of Wales Hospital, University of New South Wales, Sydney; The Whiteley-Martin Research Centre, University of Sydney, Nepean Hospital, Sydney.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Nagaraja
authors.affiliation: Prince of Wales Hospital, University of New South Wales, Sydney.
authors.forename: Amit
authors.initials: A
authors.lastname: Kapur
authors.affiliation: Prince of Wales Hospital, University of New South Wales, Sydney.
authors.forename: Richard
authors.initials: R
authors.lastname: Szirt
authors.affiliation: Department of Cardiology, Blacktown Hospital, Sydney. Electronic address: jwalant_21@yahoo.com.
authors.forename: Jwalant
authors.initials: J
authors.lastname: Raval
authors.affiliation: The Whiteley-Martin Research Centre, University of Sydney, Nepean Hospital, Sydney.
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
authors.affiliation: Department of Cardiology, Blacktown Hospital, Sydney.
authors.forename: David
authors.initials: D
authors.lastname: Burgess
authors.affiliation: Department of Cardiology, Blacktown Hospital, Sydney.
authors.forename: A Robert
authors.initials: AR
authors.lastname: Denniss
mesh_terms: D000787:Angina Pectoris / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic
keywords: Acute ST-segment elevation myocardial infarction; Meta-analysis; Multivessel revascularisation; Randomised trials; Two-stage revascularisation