title: Pathfinding to an optimal strategy of revascularization in primary coronary intervention in patients with multivessel disease: a network meta-analysis of randomized trials.
abstract: In ST-segment elevation myocardial infarction (STEMI), current guidelines discourage treatment of the non-culprit lesions at the time of the primary intervention. Latest trials have challenged this strategy suggesting benefit of early complete revascularization. We performed a Bayesian multiple treatment network meta-analysis of randomized clinical trials (RCTs) in STEMI on culprit-only intervention (CO) versus different timing multivessel revascularization, including immediate (IM), same hospitalization (SH) or later staged (ST).
  
  
  
  Outcome parameters were pooled with a random-effects model. For multiple-treatment meta-analysis, a Bayesian Markov chain Monte Carlo method was used.
  
  
  
  Eight RCTs involving 2077 patients were identified. ST and IM revascularization was associated with a decrease in major adverse cardiac events (MACEs) compared to culprit-only approach (risk ratio [RR]: 0.43 credible interval [CrI]: 0.22-0.77 and RR: 0.36 CrI: 0.24-0.54, respectively). IM was superior to SH (RR: 0.49 CrI: 0.29-0.80). With regards to myocardial infarction IM was superior to SH (RR: 0.18 CrI: 0.02-0.99). The posterior probability of being the best choice of treatment regarding the frequency of MACEs was 71.2% for IM, 28.5% for ST, 0.3% for SH and 0.05% for culprit-only approach.
  
  
  
  Results from RCTs indicate that immediate or staged revascularization of non-culprit lesions reduces major adverse events in patients after primary percutaneous coronary intervention. Differences in MACEs suggest superiority of the immediate or staged intervention; however, further randomized trials are needed to determine the optimal timing of revascularization of the non-culprit lesions.
authors.affiliation: a University of Pécs, Heart Institute , Department of Interventional Cardiology , Pécs , Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Komócsi
authors.affiliation: b University of Pécs , Faculty of Business and Economics, Department of Statistics and Econometrics , Pécs , Hungary.
authors.forename: Dániel
authors.initials: D
authors.lastname: Kehl
authors.affiliation: c Division of Cardiology, Department of Internal Medicine , Citta della Salute e della Scienza , Turin , Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: d'Ascenso
authors.affiliation: d Saint Luke's Mid America Heart Institute , Kansas City , Missouri , USA.
authors.forename: James
authors.initials: J
authors.lastname: DiNicolantonio
authors.affiliation: a University of Pécs, Heart Institute , Department of Interventional Cardiology , Pécs , Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Vorobcsuk
mesh_terms: D001499:Bayes Theorem; D006801:Humans; D009010:Monte Carlo Method; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D016896:Treatment Outcome
keywords: Culprit; ST-segment elevation myocardial infarction; meta-analysis; multivessel; outcomes; primary percutaneous intervention