title: Meta-Analysis Comparing Complete Revascularization Versus Infarct-Related Only Strategies for Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease.
abstract: Several recent randomized controlled trials (RCTs) demonstrated better outcomes with multivessel complete revascularization (CR) than with infarct-related artery-only revascularization (IRA-OR) in patients with ST-segment elevation myocardial infarction. It is unclear whether CR should be performed during the index procedure (IP) at the time of primary percutaneous coronary intervention (PCI) or as a staged procedure (SP). Therefore, we performed a pairwise meta-analysis using a random-effects model and network meta-analysis using mixed-treatment comparison models to compare the efficacies of 3 revascularization strategies (IRA-OR, CR-IP, and CR-SP). Scientific databases and websites were searched to find RCTs. Data from 9 RCTs involving 2,176 patients were included. In mixed-comparison models, CR-IP decreased the risk of major adverse cardiac events (MACEs; odds ratio [OR] 0.36, 95% CI 0.25 to 0.54), recurrent myocardial infarction (MI; OR 0.50, 95% CI 0.24 to 0.91), revascularization (OR 0.24, 95% CI 0.15 to 0.38), and cardiovascular (CV) mortality (OR 0.44, 95% CI 0.20 to 0.87). However, only the rates of MACEs, MI, and CV mortality were lower with CR-SP than with IRA-OR. Similarly, in direct-comparison meta-analysis, the risk of MI was 66% lower with CR-IP than with IRA-OR, but this advantage was not seen with CR-SP. There were no differences in all-cause mortality between the 3 revascularization strategies. In conclusion, this meta-analysis shows that in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease, CR either during primary PCI or as an SP results in lower occurrences of MACE, revascularization, and CV mortality than IRA-OR. CR performed during primary PCI also results in lower rates of recurrent MI and seems the most efficacious revascularization strategy of the 3.
authors.affiliation: Section of Cardiology, School of Medicine, University of Tennessee, Memphis, Tennessee; Veterans Affairs Medical Center, Memphis, Tennessee. Electronic address: Shahcardiology@yahoo.com.
authors.forename: Rahman
authors.initials: R
authors.lastname: Shah
authors.affiliation: West Virginia University Heart Institute, Morgantown, West Virginia.
authors.forename: Chalak
authors.initials: C
authors.lastname: Berzingi
authors.affiliation: Pinnacle Health, Wormleysburg, Pennsylvania.
authors.forename: Mubashir
authors.initials: M
authors.lastname: Mumtaz
authors.affiliation: Section of Cardiology, School of Medicine, University of Tennessee, Memphis, Tennessee.
authors.forename: John B
authors.initials: JB
authors.lastname: Jasper
authors.affiliation: Section of Cardiology, School of Medicine, University of Tennessee, Memphis, Tennessee.
authors.forename: Rohan
authors.initials: R
authors.lastname: Goswami
authors.affiliation: Section of Cardiology, School of Medicine, University of Tennessee, Memphis, Tennessee.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Morsy
authors.affiliation: Section of Cardiology, School of Medicine, University of Tennessee, Memphis, Tennessee; Veterans Affairs Medical Center, Memphis, Tennessee.
authors.forename: Kodangudi B
authors.initials: KB
authors.lastname: Ramanathan
authors.affiliation: The Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D004562:Electrocardiography; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000592:standards*; D017410:Practice Guidelines as Topic; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000601:surgery*