Complete versus culprit-vessel only revascularization in STEMI: An updated meta-analysis of randomized control trials☆

Gupta, Kartik; Chopra, Lakshay; Salame, Ameen; Gharpure, Nitin; Prejean, Shane; Mering, Gregory Von; Solaiman, Firas Al; Eudailey, Kyle W.; Bajaj, Navkaranbir S.; Ahmed, Mustafa I.

doi:10.1016/j.ijcha.2020.100481

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…With the weight of evidence (meta-analyses) 19,20 and the COMPLETE trial supporting complete revascularisation, 6 the main outstanding question remains 'when' the complete revascularisation is performed. This study provides real world data to support the idea of in-patient or early outpatient complete revascularisation being comparable.…”

Section: Discussionmentioning

confidence: 99%

An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention

Rathod

Spagnolo

Elliott

et al. 2020

Clin Med Insights Cardiol

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Background: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with single vessel disease. Whilst evidence now exists to support complete revascularisation for bystander disease the optimal timing is still debated. This study aimed to compare clinical outcomes in patients with STEMI and multi-vessel disease who underwent complete revascularisation as inpatients in comparison to patients who had staged PCI as early outpatients. Methods and results: We conducted an observational cohort study consisting of 1522 patients who underwent primary PCI with multi-vessel disease from 2012 to 2019. Exclusions included patients with cardiogenic shock and previous CABG. Patients were split into 2 groups depending on whether they had complete revascularisation performed as inpatients or as staged PCI at later outpatient dates. The primary outcome of this study was major adverse cardiac events (consisting of myocardial infarction, target vessel revascularisation and all-cause mortality). 834 (54.8%) patients underwent complete inpatient revascularisation and 688 patients (45.2%) had outpatient PCI (median 43 days post discharge). Of the inpatient group, 652 patients (78.2%) underwent complete revascularisation during the index procedure whilst 182 (21.8%) patients underwent inpatient bystander PCI in a second procedure. Overall, there were no significant differences between the groups with regards to their baseline or procedural characteristics. Over the follow-up period there was no significant difference in MACE between the cohorts ( P = .62), which persisted after multivariate adjustment (HR 1.21 [95% CI 0.72-1.96]). Furthermore, in propensity-matched analysis there was no significant difference in outcome between the groups (HR: 0.86 95% CI: 0.75-1.25). Conclusions: Our study demonstrated that the timing of bystander PCI after STEMI did not appear to have an effect on cardiovascular outcomes. We suggest that patients with multi-vessel disease can potentially be discharged promptly and undergo early outpatient bystander PCI. This could significantly reduce length of stay in hospital.

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Section: Discussionmentioning

confidence: 99%

An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention

Rathod

Spagnolo

Elliott

et al. 2020

Clin Med Insights Cardiol

View full text Add to dashboard Cite

show abstract

“…A recent meta-analysis suggested that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE and cardiovascular mortality without increasing the risk of adverse safety outcomes [18] . Furthermore, Gupta et al present a subgroup analysis of early vs delayed complete revascularization showing similar MACE rates for either strategy [19] . Thus, the optimal timing of revascularization completion between staged PCI before hospital discharge (early) and staged PCI after discharge (delayed) remains unclear [20] .…”

Section: Acute Myocardial Infarctionmentioning

confidence: 97%

Recent highlights on acute myocardial infarction and takotsubo syndrome from the International Journal of Cardiology: Heart & Vasculature

Tedeschi

Ammirati

Contri

et al. 2022

IJC Heart & Vasculature

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Complete versus culprit-vessel only revascularization in STEMI: An updated meta-analysis of randomized control trials☆

Cited by 2 publications

References 20 publications

An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention

An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention

Recent highlights on acute myocardial infarction and takotsubo syndrome from the International Journal of Cardiology: Heart & Vasculature

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