title: Complete versus culprit-only revascularization in patients with multi-vessel disease undergoing primary percutaneous coronary intervention: A meta-analysis of randomized trials.
abstract: BACKGROUND
  The best approach for revascularization of multi-vessel coronary disease in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) is controversial.
  
  
  METHODS
  We searched the Medline and Web of Science databases, the Cochrane Register of Controlled Trials, and major conference proceedings for clinical trials that randomized STEMI patients with multi-vessel disease to a complete versus culprit-only revascularization strategy. Random effects summary risk ratios (RR) were constructed using a DerSimonian-Laird model.
  
  
  RESULTS
  A total of 6 trials met our selection criteria, which yielded 1,190 patients. The mean follow-up duration was 20.5 months. The incidence of major adverse cardiac events was significantly reduced in the complete revascularization group versus the culprit-only revascularization group (RR 0.57, 95% confidence interval (CI) 0.41-0.78, p < 0.001). This was due to a lower risk of urgent revascularization with complete revascularization (RR 0.55, 95% CI 0.35-0.86, p = 0.01). A non-significant reduction was observed with complete versus culprit-only revascularization for the combined outcome of mortality or myocardial infarction (RR 0.56, 95% CI 0.30-1.04, p = 0.06).
  
  
  CONCLUSIONS
  Complete revascularization of significant coronary lesions at the time of primary PCI in patients with STEMI and multi-vessel disease was associated with better outcomes. This was primarily due to a reduction in the need for urgent revascularization. Larger trials are needed to determine if complete revascularization reduces death or myocardial infarction.
authors: Department of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL, 32610, USA. Electronic address: islam.elgendy@medicine.ufl.edu.
authors: Islam Y
authors: IY
authors: Elgendy
authors: Department of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL, 32610, USA. Electronic address: thuo@ufl.edu.
authors: Tianyao
authors: T
authors: Huo
authors: Department of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL, 32610, USA. Electronic address: ahmed.mahmoud@medicine.ufl.edu.
authors: Ahmed
authors: A
authors: Mahmoud
authors: Department of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100277, Gainesville, FL, 32610, USA; North Florida/South Georgia Veterans Health Systems, 1601 SW Archer Road, Gainesville, FL 32608, USA. Electronic address: anthony.bavry@va.gov.
authors: Anthony A
authors: AA
authors: Bavry
mesh_terms: D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods*; D062645:Percutaneous Coronary Intervention; D011300:Preoperative Care / Q000379:methods*
keywords: Multivessel coronary artery disease; Myocardial infarction; Primary percutaneous coronary intervention; Revascularization