title: Multivessel versus Single Vessel Angioplasty in Non-ST Elevation Acute Coronary Syndromes: A Systematic Review and Metaanalysis.
abstract: BACKGROUND
  Multivessel disease is common in acute coronary syndrome patients. However, if multivessel percutaneous coronary intervention is superior to culprit-vessel angioplasty has not been systematically addressed.
  
  
  METHODS
  A metaanalysis was conducted including studies that compared multivessel angioplasty with culprit-vessel angioplasty among non-ST elevation ACS patients. Since all studies were observational adjusted estimates of effects were used. Pooled estimates of effects were computed using the generic inverse of variance with a random effects model.
  
  
  RESULTS
  Twelve studies were included (n = 117,685). Median age was 64.1 years, most patients were male, 29.3% were diabetic and 36,9% had previous myocardial infarction. Median follow-up was 12 months. There were no significant differences in mortality risk (HR 0.79; 95% CI 0.58 to 1.09; I2 67.9%), with moderate inconsistency. Also, there were no significant differences in the risk of death or MI (HR 0.90; 95% CI 0.69 to 1.17; I2 62.3%), revascularization (HR 0.76; 95% CI 0.55 to 1.05; I2 49.9%) or in the combined incidence of death, myocardial infarction or revascularization (HR 0.83; 95% CI 0.66 to 1.03; I2 70.8%). All analyses exhibited a moderate degree of inconsistency. Subgroup analyses by design reduced the inconsistency of the analyses on death or myocardial infarction, revascularization and death, myocardial infarction or revascularization. There was evidence of publication bias (Egger's test p = 0.097).
  
  
  CONCLUSIONS
  Routine multivessel angioplasty in non-ST elevation acute coronary syndrome patients with multivessel disease was not superior to culprit-vessel angioplasty. Randomized controlled trials comparing safety and effectiveness of both strategies in this setting are needed.
authors.affiliation: Cardiology Department, Hospital El Cruce "Néstor Carlos Kirchner", Av. Calchaquí 5401 (B1888AAE), Florencio Varela, Buenos Aires, Argentina.|Fundación GESICA, Av. Rivadavia 2358 (C1034ACP), Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Javier
authors.initials: J
authors.lastname: Mariani
authors.affiliation: Fundación GESICA, Av. Rivadavia 2358 (C1034ACP), Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Macchia
authors.affiliation: Cardiology Department, Hospital El Cruce "Néstor Carlos Kirchner", Av. Calchaquí 5401 (B1888AAE), Florencio Varela, Buenos Aires, Argentina.
authors.forename: Maximiliano
authors.initials: M
authors.lastname: De Abreu
authors.affiliation: Cardiology Department, Hospital El Cruce "Néstor Carlos Kirchner", Av. Calchaquí 5401 (B1888AAE), Florencio Varela, Buenos Aires, Argentina.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gonzalez Villa Monte
authors.affiliation: Cardiology Department, Hospital El Cruce "Néstor Carlos Kirchner", Av. Calchaquí 5401 (B1888AAE), Florencio Varela, Buenos Aires, Argentina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Tajer
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D017130:Angioplasty; D001808:Blood Vessels / Q000473:pathology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D017594:Publication Bias; D016896:Treatment Outcome; D014463:Ultrasonography