Meta-Analysis Comparing Complete Revascularization Versus Infarct-Related Only Strategies for Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

Revascularization strategies in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: urgent or staged?

“…Unfortunately, this conclusion, which would represent excellent news for the interventional community considering the complexity of MV-PCI in the setting of a STEMI, has not been confirmed by other recent meta-analysis that used only data from randomized clinical trials. Indeed, Shah et al (8), using data from nine randomized trials conclude that MV-PCI either during primary PCI or as an staged procedure resulted in lower occurrences of major adverse cardiac events, revascularization, and cardiovascular mortality than IRA-only PCI. Because single-procedure MV-PCI also resulted in lower rates of recurrent myocardial infarction, they recommended single-procedure MV-PCI as the most efficacious revascularization strategy of the 3.…”

Complete versus incomplete revascularization with drug‐eluting stents for multi‐vessel disease in stable, unstable angina or non‐ST‐segment elevation myocardial infarction: A meta‐analysis

“…Multi‐vessel coronary artery disease (MVD) is relatively common in coronary artery disease and poses challenges to revascularization strategy. Complete revascularization (CR) versus incomplete revascularization (IR) in MVD with percutaneous coronary intervention (PCI) has been investigated in several studies for various form of coronary artery disease . The outcomes were in favor of CR in ST‐segment elevation myocardial infarction (STEMI) with MVD .…”

Complete versus culprit only revascularization in ST-elevation myocardial infarction—a perspective on recent trials and recommendations

“…They have discordant results, which was largely driven by the inclusion of different variety of trials to conduct the meta-analyses and by the fact that none of the RCTs were adequately powered for the hard outcomes of death and MI. Overall, MV-PCI seems to be associated with lower risk of MACE, repeat revascularization, but with a similar risks of recurrent MI and mortality compared to culprit-only revascularization (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44).…”

“…A separate metaanalysis which recruited nine RCTs with total 2,176 patients, agreed that complete revascularization strategy was overall better in lowering risk of MACE, repeat revascularization, cardiovascular mortality, but found no difference in mortality or recurrent MI. The investigators also compared the three revascularization strategies (culprit-only, complete revascularization at index procedure, and complete revascularization as staged procedure) and showed that complete revascularization during index procedure seemed to be more superior than two other strategies (33). However, more recent meta-analysis, conducted by Fan et al (34), concluded the opposite: complete revascularization as staged procedure deemed better than immediate complete revascularization or culprit-only revascularization in reducing all-cause mortality (34).…”