scholarly journals Complete Revascularization by Percutaneous Coronary Intervention for Patients With ST‐Segment–Elevation Myocardial Infarction and Multivessel Coronary Artery Disease: An Updated Meta‐Analysis of Randomized Trials

2020 ◽  
Vol 9 (12) ◽  
Author(s):  
Yousif Ahmad ◽  
James P. Howard ◽  
Ahran Arnold ◽  
Megha Prasad ◽  
Henry Seligman ◽  
...  
Keyword(s):  
Randomized Trials ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: a meta-analysis of randomized controlled trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Bajraktari ◽  
I Bytyci ◽  
M.Y Henein ◽  
F Alfonso ◽  
A Ahmed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Meta Analysis ◽  
Total Mortality ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Randomized Controlled ◽  
St Segment ◽  
Artery Disease

Abstract Background The recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesion had a reduced risk of major adverse cardiac events (MACE: cardiovascular mortality, myocardial infarction, or ischemia-driven revascularization), but not of cardiovascular or total mortality. Aim To assess the efficacy of complete revascularization for cardiovascular or total mortality reduction by meta-analysis of all available randomized controlled trials (RCTs) including the COMPLETE trial. Methods PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n=3420) vs. only culprit lesion (n=3613) PCI for a median 28.7 months follow-up. Random effect risk ratios were used for efficacy and safety outcomes. Results Complete revascularization reduced the risk of MACE (10.4% vs. 16.6%; RR=0.59, 95% CI: 0.47 to 0.74, p<0.0001), CV mortality (2.87% vs. 3.72%; RR=0.73, 95% CI: 0.56 to 0.95, p=0.02), reinfarction (5.1% vs. 7.1%; RR=0.67, 95% CI: 0.52 to 0.86, p=0.002), urgent revascularization (7.92% vs. 17.4%; RR=0.47, 95% CI: 0.30 to 0.73, p<0.001), and CV hospitalization (8.68% vs. 11.4%; RR=0.65, 95% CI: 0.44to 0.96, p=0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy. Conclusion The findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes. Funding Acknowledgement Type of funding source: None

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