Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease

Bravo, Claudio; Hirji, Sameer; Bhatt, Deepak L.; Kataria, Rachna; Faxon, David P.; Ohman, E. Magnus; Anderson, Kevin L.; Sidi, Akil I; Sketch, Michael H.; Zarich, Stuart; Osho, Asishana A.; Gluud, Christian; Kelbæk, Henning; Engstrøm, Thomas; Høfsten, Dan Eik; Brennan, James M.

doi:10.1002/14651858.cd011986.pub2

Cited by 20 publications

(10 citation statements)

References 64 publications

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“…Another weakness of this meta-analysis is that although the included trials were performed in different parts of the world, some continents were underrepresented 4. For instance, none of the included trials studied patients in North America, South America or Australia.…”

Section: Discussionmentioning

confidence: 99%

Cochrane corner: complete versus culprit-only revascularisation in ST segment elevation myocardial infarction with multivessel disease

Bravo

Hirji

Bhatt

et al. 2018

Heart

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Section: Discussionmentioning

confidence: 99%

Cochrane corner: complete versus culprit-only revascularisation in ST segment elevation myocardial infarction with multivessel disease

Bravo

Hirji

Bhatt

et al. 2018

Heart

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“…refractory angina, proven ischaemia, and repeat revascularization) in the composite endpoints [2,3,6]. A meta-analysis that focused on all-cause and cardiovascular death found that CR may be better than IR [16], but the quality of evidence on which this was based was poor and the COMPLETE and COMPARE ACUTE trials were not included [4,5]. COMPLETE is the largest prospective study conducted to date and showed that CR is better than IR for the composite outcome of cardiovascular death or myocardial infarction (HR 0.74, 95% CI 0.60−0.91; p = 0.004), driven primarily by a reduction in myocardial infarction [4].…”

Section: Discussionmentioning

confidence: 99%

Complete Revascularization and Survival in STEMI

et al. 2021

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Background: Complete revascularization (CR) of ST-elevation myocardial infarction patients with multivessel coronary artery disease (MVD) has proven better regarding combined endpoints than incomplete revascularization (IR) in recent randomized control trials with no impact on survival. Objective: To retrospectively evaluate the impact of complete CR during the index hospitalization on survival in STEMI patients with MVD. Methods and results: We included all patients with MVD who underwent successful primary percutaneous coronary intervention for STEMI during their index hospitalization at the University Medical Centre Ljubljana, Slovenia (from 1 January 2009 to 3 April 2011). Coronary angiograms were reviewed for non-culprit coronary arteries (>2 mm in diameter and ≥50% stenosis) treated with percutaneous coronary intervention. Rates of all-cause and cardiovascular death were compared between 235 patients who underwent CR (N = 70) or IR (N = 165). After a median follow-up of 7.0 years (interquartile range 6.0-8.2) the CR group had lower rates of allcause death (15.7% vs 35.8%, log-rank p = 0.003) and cardiovascular death (12.9% vs 23.6%, log-rank p = 0.046). Multivariable analysis with adjustment for confounders showed no benefit of CR for all-cause death (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.31-1.18, p = 0.139) or cardiovascular death (HR 0.80, 95% CI 0.37-1.72, p = 0.560). Age, elevated serum creatinine at inclusion, diabetes and cardiogenic shock at presentation were predictors of death. Conclusions: Patients with STEMI and MVD who underwent CR showed lower all-cause and cardiovascular death during follow-up than those who underwent IR. However, after adjustment for confounders, the real determinates of survival were independent of the revascularization method.

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“…In the latter case, significant narrowings are observed in several vessels and the physician needs to decide whether to treat all the narrowings or focus on the most a↵ected coronary artery. Several randomized trials and meta-analyses found that complete revascularization, where multiple narrowed arteries are treated, was associated with lower mortality in STEMI patients with multivessel disease compared to single-artery treatment (Bravo et al, 2017). For patients with multi-vessel disease, a larger number of segments treated and stents inserted may therefore reflect a "better" treatment.…”

Section: Datamentioning

confidence: 99%

Learning-by-Doing and Productivity Growth Among High-Skilled Workers: Evidence from the Treatment of Heart Attacks

Lundborg¹,

James²,

Lagerqvist³

et al. 2021

SSRN Journal

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Any opinions expressed in this paper are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but IZA takes no institutional policy positions. The IZA research network is committed to the IZA Guiding Principles of Research Integrity. The IZA Institute of Labor Economics is an independent economic research institute that conducts research in labor economics and offers evidence-based policy advice on labor market issues. Supported by the Deutsche Post Foundation, IZA runs the world's largest network of economists, whose research aims to provide answers to the global labor market challenges of our time. Our key objective is to build bridges between academic research, policymakers and society. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author.

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Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease

Cited by 20 publications

References 64 publications

Cochrane corner: complete versus culprit-only revascularisation in ST segment elevation myocardial infarction with multivessel disease

Cochrane corner: complete versus culprit-only revascularisation in ST segment elevation myocardial infarction with multivessel disease

Complete Revascularization and Survival in STEMI

Learning-by-Doing and Productivity Growth Among High-Skilled Workers: Evidence from the Treatment of Heart Attacks

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