Complete Revascularization versus Culprit- Vessel Revascularization in Acute Myocardial Infarction: Six Months Follow-up

Omar, Walid; Mashhour, Karim; Mowafy, Ahmed; Atroush, Hatem El; Ghawaby, Helmy El

doi:10.21767/1989-5216.1000242

Cited by 4 publications

(7 citation statements)

References 17 publications

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“…The prevalence of hypertension, diabetes, and history of MI was 46.8%, 18.6%, and 7.2% respectively. CR and FFR interrogation were performed during the index procedure in three studies, 10,13,17 during the index hospitalization in five studies, 3,6,[14][15][16] and at various times in three studies. 2,11,12…”

Section: Search Resultsmentioning

confidence: 99%

Angiography versus FFR guided complete revascularization versus culprit‐only revascularization for patients presenting with STEMI: Network meta‐analysis

Okuya

Gohil

Moussa

2022

Cathet Cardio Intervent

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This study aimed to compare the outcomes of different revascularization strategies among patients presenting with ST‐segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing primary percutaneous coronary intervention (PCI). MVD is present in about one‐half of patients presenting with STEMI. Despite several randomized controlled trials (RCTs) comparing complete revascularization (CR) and culprit‐only revascularization (COR), the optimal PCI strategy for STEMI patients with MVD remains unsettled. Moreover, it is unclear whether angiography‐guided CR or fractional flow reserve (FFR)‐guided CR is associated with better outcomes. PubMed, Scopus, and Cochrane Library were searched for RCTs comparing CR strategies with COR strategy in patients with STEMI between January 1, 2000 and September 30, 2021 were identified. A frequentist network meta‐analyses were performed for three PCI strategies: (1) COR; (2) angiography‐guided CR; and (3) FFR‐guided CR. Ten RCTs including 7979 patients were included. A strategy of angiography‐guided CR or FFR‐guided CR was associated with a significantly lower rate of major adverse cardiac events (MACE) and unplanned revascularization compared with COR. Although there were no statistical significant difference between angiography‐guided CR and FFR‐guided CR, P score analysis showed that angiography‐guided CR was ranked as the best strategy for reducing MACE, all‐cause mortality, cardiovascular death, recurrent myocardial infarction, and unplanned revascularization. In patients presenting with STEMI and MVD undergoing primary PCI, angiography‐guided CR or FFR‐guided CR improve outcomes compared with COR. Furthermore, the strategy of angiography‐guided CR ranked as the best revascularization strategy in those patients.

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Section: Search Resultsmentioning

confidence: 99%

Angiography versus FFR guided complete revascularization versus culprit‐only revascularization for patients presenting with STEMI: Network meta‐analysis

Okuya

Gohil

Moussa

2022

Cathet Cardio Intervent

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“…Further, we excluded studies that were short-term reports of a trial (25)(26)(27). Finally, 12 randomized controlled trials involving 8,233 patients were included in the analysis (5,6,8,(28)(29)(30)(31)(32)(33)(34)(35)(36). The network plot in terms of primary outcome is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…The network plot in terms of primary outcome is shown in Figure 1. Eight studies compared angiography-guided CR with COR (28,(30)(31)(32)(33)(34)(35)(36), three studies compared FFR-guided CR with COR (5,6,29), and one study compared FFR-guided CR with angiography-guided CR (8). Table 1 displays the characteristics of these studies.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 displays the characteristics of these studies. The stenosis of the non-infarct vessel was >70%, following the definition of MVD, in patients included in six of the included studies (30,(32)(33)(34)(35)(36), while the other six studies defined MVD as the stenosis of the non-infarct vessel >50% (5,6,8,28,29,31). The included studies had a follow-up that ranged from 6 to 67.2 months.…”

Section: Resultsmentioning

confidence: 99%

“…First, the definition of MVD varied among the studies. For example, six studies defined MVD as an angiographic diameter stenosis >50% in more than one non-culprit artery (5,6,8,28,29,31), while the other six studies defined MVD as stenosis diameter of >70% in more than one non-culprit artery (30,(32)(33)(34)(35)(36). Nevertheless, the result of a regression analysis showed that the stenosis of the nonculprit vessel had no correlation with the event rate of primary outcome.…”

Section: Limitations Of the Studymentioning

confidence: 99%

See 2 more Smart Citations

Comparative Effectiveness of Complete Revascularization Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A Bayesian Network Meta-Analysis

Zhao

Guo

Huang

et al. 2021

Front. Cardiovasc. Med.

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Whether fractional flow reserve (FFR) should be available for revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) is controversial. We aimed to compare the efficacy of various complete revascularization (CR) regimens for STEMI patients with MVD. The PubMed and Cochrane Library databases and clinicaltrial.gov were searched for the randomized controlled trials (RCTs) comparing the FFR-guided CR, angiography-guided CR, and culprit-only revascularization (COR) strategies in STEMI patients with MVD. A Bayesian random-effect model was employed to synthesize the evidence in network meta-analysis. We used relative risk (RR) and 95% credible interval (CrI) as measures of effect size. The primary endpoint was the composite outcome of all-cause mortality or myocardial infarction (MI). Twelve RCTs were included. Angiography-guided CR showed a lower event rate of the composite outcome (RR, 0.68; 95%CrI, 0.50–0.87), all-cause mortality (RR, 0.75; 95%CrI, 0.55–0.96), MI (RR, 0.63; 95%CrI, 0.43–0.86), and repeat revascularization (RR, 0.36; 95% CrI, 0.24–0.55) compared with COR. Additionally, angiography-guided CR had a lower risk of primary outcome (RR, 0.64; 95%CrI, 0.38–0.94) and MI (RR, 0.58; 95%CrI, 0.31–0.92) than FFR-guided CR. The difference between the FFR-guided CR and COR in terms of composite outcome, all-cause mortality, and MI was similar. Angiography-guided CR was associated with the highest probability of optimal treatment for the primary outcome (98.5%), followed by FFR-guided CR (1.2%) and COR (0.3%). STEMI patients with MVD benefitted more from angiography-guided CR than from FFR-guided CR. However, only one study compared the effectiveness of FFR-guided and angiography-guided PCI; thus, the comparison between FFR-guided and angiography-guided PCI relied on indirect evidence. Therefore, further studies directly comparing the effectiveness of these two CR strategies are warranted.

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Culprit vessel only versus complete revascularization following thrombolysis in patients with ST elevation myocardial infraction and multivessel coronary artery disease - A prospective study

Jain

Dash

Iyer

2023

Indian Heart Journal

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Complete Revascularization versus Culprit- Vessel Revascularization in Acute Myocardial Infarction: Six Months Follow-up

Cited by 4 publications

References 17 publications

Angiography versus FFR guided complete revascularization versus culprit‐only revascularization for patients presenting with STEMI: Network meta‐analysis

Angiography versus FFR guided complete revascularization versus culprit‐only revascularization for patients presenting with STEMI: Network meta‐analysis

Comparative Effectiveness of Complete Revascularization Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A Bayesian Network Meta-Analysis

Culprit vessel only versus complete revascularization following thrombolysis in patients with ST elevation myocardial infraction and multivessel coronary artery disease - A prospective study

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