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Complete revascularization for patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: a meta-analysis of randomized trials

Bajraktari, Gania,b,c; Jashari, Hakia,b; Ibrahimi, Pranveraa,b; Alfonso, Fernandod; Jashari, Fisnika,c; Ndrepepa, Gjine; Elezi, Shpendc; Henein, Michael, Y.a,f

doi: 10.1097/MCA.0000000000000602
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Introduction Despite the recent findings in randomized clinical trials (RCTs) with limited sample sizes and the updates in clinical guidelines, the current available data for the complete revascularization (CR) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) at the time of primary percutaneous coronary intervention (PCI) are still contradictory.

Aim The aim of this meta-analysis of the existing RCTs was to assess the efficacy of the CR versus revascularization of infarct-related artery (IRA) only during primary PCI in patients with STEMI and multivessel disease (MVD).

Patients and methods We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases aiming to find RCTs for patients with STEMI and MVD which compared CR with IRA-only. Random effect risk ratios (RRs) were calculated for efficacy and safety outcomes.

Results Ten RCTs with 3291 patients were included. The median follow-up duration was 17.5 months. Major adverse cardiac events (RR=0.57; 0.43–0.76; P<0.0001), cardiac mortality (RR=0.52; 0.31–0.87; P=0.014), and repeat revascularization (RR=0.50; 0.30–0.84; P=0.009) were lower in CR compared with IRA-only strategies. However, there was no significant difference in the risk of all-cause mortality, recurrent nonfatal myocardial infarction, stroke, major bleeding events, and contrast-induced nephropathy.

Conclusion For patients with STEMI and MVD undergoing primary PCI, the current evidence suggests that the risk of major adverse cardiac events, repeat revascularization, and cardiac death is reduced by CR. However, the risk for all-cause mortality and PCI-related complications is not different from the isolated culprit lesion-only treatment. Although these findings support the cardiac mortality and safety benefit of CR in stable STEMI, further large trials are required to provide better guidance for optimum management of such patients.

aDepartment of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

bClinic of Cardiology, University Clinical Centre of Kosova

cDepartment of Internal Medicine, Medical Faculty, University of Prishtina, Prishtina, Republic of Kosovo

dCardiac Department, La Princesa University Hospital, Institute of Health Research, IIS-IP, University Autonoma of Madrid, Madrid, Spain

eDepartment of Adult Cardiology, German Heart Centre Munich, Technical University of Munich, Germany

fSt George University, London, UK

Correspondence to Gani Bajraktari, MD, FESC, FACC, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden Tel: +46 907 850 000; fax: +46 90 13 76 33; e-mail: gani.bajraktari@umu.se

Received October 8, 2017

Received in revised form November 26, 2017

Accepted November 27, 2017

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