title: Culprit-lesion only versus complete multivessel percutaneous intervention in ST-elevation myocardial infarction: A systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel (MV) coronary artery disease (CAD) is associated with poor outcomes. Percutaneous coronary intervention (PCI) of the culprit-lesion only (CLO) as compared with a MV PCI approach to revascularization remains uncertain. Our objective is to gain a better understanding of the efficacy and safety of CLO as compared with MV PCI in patients with STEMI by conducting an updated meta-analysis.
  
  
  METHODS
  A comprehensive search of PubMed, CENTRAL, EMBASE, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar databases of randomized controlled trials (RCTs) was performed.
  
  
  RESULTS
  Seven RCTs were included, enrolling a total of 2006 patients. We found that there was a significant reduction in major adverse cardiovascular events (MACE) (OR, 0.62; 95% CI, 0.43-0.90), cardiovascular mortality (OR, 0.46; 95% CI, 0.27-0.80), and repeat revascularization (RRV) (OR, 0.39; 95% CI, 0.30-0.51) favoring MV over the CLO approach for patients undergoing primary PCI. The number needed to treat in order to prevent one CV mortality, RRV, or MACE event is 47, 11, and 16 patients, respectively. No differences were observed between MV vs. CLO PCI for subsequent myocardial infarction (OR, 0.74; 95% CI, 0.40-1.39), all-cause mortality (OR, 0.78; 95% CI, 0.53-1.15), non-cardiovascular mortality (OR, 1.35; 95% CI, 0.74-2.48), all-bleeding events (OR, 0.82; 95% CI, 0.40-1.65), contrast-induced nephropathy (OR, 0.72; 95% CI, 0.33-1.54), and stroke (OR, 1.28; 95% CI, 0.47-3.46).
  
  
  CONCLUSIONS
  MV PCI significantly reduces the rate of MACE, CV mortality, and RRV without significant harm as compared to CLO PCI.
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA. Electronic address: pedrovillablanca@hotmail.com.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Villablanca
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Briceno
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA.
authors.forename: Daniele
authors.initials: D
authors.lastname: Massera
authors.affiliation: International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic.
authors.forename: Ota
authors.initials: O
authors.lastname: Hlinomaz
authors.affiliation: Department of Internal Medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA.
authors.forename: Marissa
authors.initials: M
authors.lastname: Lombardo
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Bortnick
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Menegus
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Pyo
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA.
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
authors.affiliation: Cardiovascular Division, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
authors.forename: Farouk
authors.initials: F
authors.lastname: Mookadam
authors.affiliation: Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
authors.forename: Harish
authors.initials: H
authors.lastname: Ramakrishna
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Wiley
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: Michela
authors.initials: M
authors.lastname: Faggioni
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
mesh_terms: D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods*; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Meta-analysis; Multivessel; ST-segment elevation myocardial infarction