Multivessel PCI decreases reinfarction risk in STEMI patients: JACC
USA: Multivessel PCI versus culprit-vessel only PCI lowers risk for reinfarction without any difference in all-cause mortality in STEMI patients, according to a recent study published in the journal JACC: Cardiovascular Interventions. The study included patients with STEMI and multivessel CAD who underwent PCI, it found that those who had multivessel PCI had a lower reinfarction rate than those who had culprit-vessel-only PCI.
About one-half of the patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (CAD). Randomized controlled trials comparing multivessel and culprit vessel–only PCI have yielded conflicting results regarding the benefits of a multivessel PCI strategy.
The goal of this systematic review and meta-analysis by Varunsiri Atti, Department of Internal Medicine, Michigan State University, Lansing, Michigan, and colleagues was to provide a comprehensive evaluation of contemporary randomized trials that addressed the safety and efficacy of multivessel versus culprit vessel–only percutaneous coronary intervention (PCI) among patients with STEMI and multivessel CAD.
The researchers performed a comprehensive search of RCTs that compared multivessel PCI with culprit vessel–only PCI fro inception to September 15, 2019. A meta-analysis was performed using a random-effects model to calculate the risk ratio (RR) and 95% confidence interval (CI). Primary efficacy outcomes were all-cause mortality and reinfarction.
A total of 10 RCTs were included consisting of 7,030 patients -- 3,426 underwent multivessel PCI and 3,604 received culprit vessel–only PCI.
Key findings of the study include:
- Compared with culprit vessel–only PCI, multivessel PCI was associated with no significant difference in all-cause mortality (RR: 0.85) and lower risk for reinfarction (RR: 0.69), cardiovascular mortality (RR: 0.71), and repeat revascularization (RR: 0.34).
- Major bleeding (RR: 0.92), stroke (RR: 1.15), and contrast-induced nephropathy (RR: 1.25) were not significantly different between the 2 groups.
"Multivessel PCI was associated with a lower risk for reinfarction, without any difference in all-cause mortality, compared with culprit vessel–only PCI in patients with ST-segment elevation myocardial infarction," concluded the authors.
The study, "Multivessel Versus Culprit-Only Revascularization in STEMI and Multivessel Coronary Artery Disease: Meta-Analysis of Randomized Trials," is published in the journal JACC: Cardiovascular Interventions.
DOI: https://doi.org/10.1016/j.jcin.2020.04.055
