title: Complete Versus Culprit-Only Revascularization for Patients With Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention: An Updated Meta-Analysis of Randomized Trials.
abstract: OBJECTIVE
  To perform an updated meta-analysis to determine whether complete revascularization of significant coronary lesions at the time of primary percutaneous coronary intervention (PCI) would be associated with better outcomes compared with culprit-only revascularization.
  
  
  BACKGROUND
  Individual trials have demonstrated conflicting evidence regarding the optimum revascularization strategy at the time of primary PCI.
  
  
  METHODS
  Clinical trials that randomized ST elevation myocardial infarction (STEMI) patients with multi-vessel disease to a complete versus culprit-only revascularization strategy were included. Random effects summary risk ratios (RR) were constructed using a DerSimonian-Laird model. The primary outcome of interest was mortality or myocardial infarction (MI).
  
  
  RESULTS
  A total of seven trials with 1,939 patients were included in the analysis. Compared with culprit-only revascularization, complete revascularization was associated with a non-significant reduction in the risk of mortality or MI (RR 0.69, 95% confidence interval (CI) 0.42-1.12, P = 0.14). Complete revascularization was associated with a reduced risk of major adverse cardiac events (MACE) (RR 0.61, 95% CI 0.45-0.81, P < 0.001), due to a significant reduction in urgent revascularization (RR 0.46, 95% CI 0.29-0.70, P < 0.001). The risk of major bleeding and contrast-induced nephropathy was similar with both approaches (RR 0.83, 95% CI 0.41-1.71, P = 0.62, and RR 0.94, 95% CI 0.42-2.12, P = 0.82).
  
  
  CONCLUSIONS
  Complete revascularization of all significant coronary lesions at the time of primary PCI was associated with a reduction in the risk of MACE due to reduction in the risk of urgent revascularization. This approach appears to be safe, with no excess major bleeding, or contrast-induced nephropathy. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Islam Y
authors.initials: IY
authors.lastname: Elgendy
authors.affiliation: Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Xuerong
authors.initials: X
authors.lastname: Wen
authors.affiliation: Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mahmoud
authors.affiliation: Department of Medicine, University of Florida, Gainesville, Florida. anthony.bavry@va.gov.|North Florida/South Georgia Veterans Health Systems, Gainesville, Florida. anthony.bavry@va.gov.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: meta-analysis; myocardial infarction; percutaneous coronary intervention