Meta-analysis: Multivessel PCI lowers reinfarction risk in STEMI
In a meta-analysis of trials of patients with STEMI and multivessel CAD who underwent PCI, those who had multivessel PCI had a lower rate of reinfarction than those who had culprit-vessel-only PCI.
There was no difference between the groups in all-cause mortality, according to the study published in JACC: Cardiovascular Interventions.
The researchers analyzed 7,030 patients from 10 randomized controlled trials. The primary outcomes were reinfarction and all-cause mortality. Average follow-up was 25 months (interquartile range, 12-36) and the timing of staged revascularization in the multivessel PCI group ranged from 2 to 57 days after the index PCI for the culprit vessel.
The following outcomes favored the multivessel PCI group compared with the culprit-vessel-only group:
- reinfarction (RR = 0.69; 95% CI, 0.5-0.95);
- CV mortality (RR = 0.71; 95% CI, 0.5-1); and
- repeat revascularization (RR = 0.34; 95% CI, 0.25-0.44).
There was no difference between the groups in the following outcomes:
- all-cause mortality (RR = 0.85; 95% CI, 0.68-1.05);
- major bleeding (RR = 0.92; 95% CI, 0.5-1.67);
- stroke (RR = 1.15; 95% CI, 0.65-2.01); and
- contrast-induced nephropathy (RR = 1.25; 95% CI, 0.8-1.95).
“The magnitude of benefit of multivessel PCI in patients with STEMI is strikingly
similar to that observed previously with multivessel revascularization in patients with stable CAD, suggesting that multivessel revascularization may be beneficial irrespective of the clinical syndrome at presentation in certain high-risk group of patients,” Varunsiri Atti, MD, internal medicine resident at Michigan State University, and colleagues wrote.
In a related editorial, Khaldoon Alaswad, MD, and Mohammad Alqarqaz, MD, both from Henry Ford Hospital, wrote: “We are more certain that complete revascularization after STEMI is better than culprit-only revascularization; however, we remain unsure about
which lesion and when to revascularize.”
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