Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled t
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ORIGINAL PAPER
Multivessel versus culprit‑only PCI in STEMI patients with multivessel disease: meta‑analysis of randomized controlled trials Hans‑Josef Feistritzer1,2 · Alexander Jobs1,2,3 · Suzanne de Waha‑Thiele3 · Ingo Eitel3 · Anne Freund1,2 · Mohamed Abdel‑Wahab1,2 · Steffen Desch1,2 · Holger Thiele1,2 Received: 3 February 2020 / Accepted: 17 March 2020 © The Author(s) 2020
Abstract Aims To perform a pairwise meta-analysis of randomized controlled trials (RCTs) comparing multivessel percutaneous coronary intervention (PCI) and culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI) patients without cardiogenic shock. Methods We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for RCTs comparing multivessel PCI with culprit vessel-only PCI in STEMI patients without cardiogenic shock and multivessel coronary artery disease. Only RCTs reporting mortality or myocardial reinfarction after at least 6 months following randomization were included. Hazard ratios (HRs) were pooled using random-effect models. Results Nine RCTs were included in the final analysis. In total, 523 (8.3%) of 6314 patients suffered the combined primary endpoint of death or non-fatal reinfarction. This primary endpoint was significantly reduced with multivessel PCI compared to culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43–0.93; p = 0.03). This finding was driven by a reduction of non-fatal reinfarction (HR 0.64, 95% CI 0.52–0.79; p = 0.001), whereas no significant reduction of all-cause death (HR 0.77, 95% CI 0.44–1.35; p = 0.28) or cardiovascular death (HR 0.64, 95% CI 0.37–1.11; p = 0.09) was observed. Conclusions In STEMI patients without cardiogenic shock multivessel PCI reduced the risk of death or non-fatal reinfarction compared to culprit vessel-only PCI. Keywords ST-elevation myocardial infarction · Multivessel coronary artery disease · Culprit vessel · Revascularization
Introduction
Hans-Josef Feistritzer and Alexander Jobs should both be considered as first authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-020-01637-6) contains supplementary material, which is available to authorized users. * Holger Thiele [email protected]‑leipzig.de 1
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
2
Leipzig Heart Institute, Leipzig, Germany
3
Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
Approximately 50% of patients with ST-elevation myocardial infarction (STEMI) present with multivessel coronary artery disease at the time of primary percutaneous coronary intervention (PCI), which is associated with worse prognosis [1–3]. The optimal management of additional stenoses in non-culprit coronary arteries is still under debate. While earlier observational studies reported worse outcomes with multivessel revas
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