title: The optimal strategy of percutaneous coronary intervention for ST-elevation myocardial infarction patients with multivessel disease: an updated meta-analysis of 9 randomized controlled trials.
abstract: BACKGROUND
  The optimal strategy of percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD) still remains controversial. This study sought to explore the optimal PCI strategy for those patients.
  
  
  METHODS
  Medline, EMBASE and the Cochrane Controlled Trials Registry were searched for relevant studies. We analyzed the comparison of major adverse cardiac events (MACEs) as the primary end point between the preventive PCI strategy and the culprit only PCI strategy (CV-PCI). The further analysis of two subgroups described as the complete multivessel PCI strategy during primary procedure (CMV-PCI) and the staged PCI strategy (S-PCI) was also performed.
  
  
  RESULTS
  Nine randomized trials were identified. The risk of MACEs was reduced significantly regarding to preventive PCI strategy (OR=0.41, 95% CI: 0.31-0.53, P<0.001) compared to CV-PCI strategy. There were lower risks of long-term mortality, reinfarction and repeat revascularization in the preventive PCI group compared to the CV-PCI group (OR=0.41, 95% CI: 0.27-0.62, P<0.001; OR=0.54, 95% CI: 0.32-0.91, P=0.021; OR=0.37, 95% CI: 0.26-0.51, P<0.001). Subgroup analysis showed that staged PCI strategy reduced the incidence of long-term mortality versus CMV-PCI strategy.
  
  
  CONCLUSIONS
  The preventive PCI is associated with the lower risk of MACEs in STEMI patients with MVD compared to the CV-PCI strategy, and the S-PCI strategy seems to be an optimal choice for these patients rather than the CMV-PCI.
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Zhong G
authors.initials: ZG
authors.lastname: Fan
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.|Department of Cardiology, Nanjing Heart Center, Nanjing, China.
authors.forename: Xiao F
authors.initials: XF
authors.lastname: Gao
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.|Department of Cardiology, Nanjing Heart Center, Nanjing, China.
authors.forename: Xiao B
authors.initials: XB
authors.lastname: Li
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.|Department of Cardiology, Nanjing Heart Center, Nanjing, China.
authors.forename: Wen X
authors.initials: WX
authors.lastname: Mao
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Li W
authors.initials: LW
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China - tiannailiang@163.com.|Department of Cardiology, Nanjing Heart Center, Nanjing, China.
authors.forename: Nai L
authors.initials: NL
authors.lastname: Tian
mesh_terms: D023381:Endpoint Determination; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D000072657:ST Elevation Myocardial Infarction / Q000601:surgery*; D016896:Treatment Outcome