Meta-analysis of multivessel versus culprit-only percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome and multivessel coronary disease.
Even in the era of contemporary drug-eluting stents, it is not clear whether percutaneous coronary intervention (PCI) for nonculprit lesions can improve long-term outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with multivessel coronary disease. Relevant studies published through August 2014 were searched and identified in the electronic databases. Summary estimates were obtained using a random-effects model. From 368 initial citations, 8 observational studies with 8,425 patients (3,227 multivessel and 5,198 culprit-only PCI) were included. Mean follow-up duration was 18 months. There were no significant differences in all-cause mortality (odds ratios [ORs] 0.85, 95% confidence interval [CI] 0.70 to 1.04) and myocardial infarction (OR 0.86, 95% CI 0.55 to 1.35). However, multivessel PCI was associated with a significantly lower rate of repeat revascularization (OR 0.75, 95% CI 0.56 to 1.00). Comparison of multivessel versus culprit-only PCI disclosed OR for major adverse cardiac events of 0.74 (95% CI 0.57 to 0.97). In conclusion, multivessel PCI reduced repeat revascularization without significant benefits in terms of mortality or myocardial infarction at the long-term follow-up in patients with NSTE-ACS and multivessel coronary disease. Future randomized studies that examine the safety and efficacy of multivessel PCI in NSTE-ACS are warranted.
Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea. Electronic address: jsjang71@gmail.com.
Jae-Sik
JS
Jang
Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
Han-Young
HY
Jin
Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
Jeong-Sook
JS
Seo
Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
Tae-Hyun
TH
Yang
Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
Dae-Kyeong
DK
Kim
Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
Dong-Soo
DS
Kim
Department of Cardiology, Kosin University Medical Center, Busan, Korea.
Kyoung-Im
KI
Cho
Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
Bo-Hyun
BH
Kim
Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Yong Hyun
YH
Park
Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Hyung-Gon
HG
Je
D054058:Acute Coronary Syndrome / Q000503:physiopathology / Q000601:surgery*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery; D004562:Electrocardiography; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016896:Treatment Outcome