Study Supports Complete Revascularization During Primary PCI in Multivessel Disease
May 11, 2018—Findings from a study of complete revascularization during primary percutaneous coronary intervention (PCI) in patients with multivessel disease versus a culprit vessel–only strategy were published by Vincenzo Pasceri, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2018;11:833–843).
According to the investigators, although several trials have compared complete with culprit-only revascularization in ST-segment elevation myocardial infarction (STEMI), it is unclear whether complete revascularization leads to improvement in hard endpoints (death and MI). The investigators conducted a meta-analysis of randomized trials to compare complete revascularization with a culprit-only strategy in patients presenting with MI and multivessel disease.
As summarized in JACC: Cardiovascular Interventions, the investigators systematically searched published research to identify randomized trials that compared complete revascularization with culprit-only revascularization in patients with STEMI without cardiogenic shock. They performed a random-effects meta-analysis that compared clinical outcomes in the two groups.
Eleven trials were identified that were composed of a total of 3,561 patients.
Compared with a culprit-only strategy, the complete revascularization significantly reduced the risk for death or MI (relative risk [RR], 0.76; 95% confidence interval [CI], 0.58–0.99; P = .04). Meta-regression showed that performing complete revascularization at the time of primary PCI was associated with better outcomes (P = .016).
The six trials performing complete revascularization during primary PCI (immediate revascularization) were associated with a significant reduction in risk for both total mortality (RR, 0.62; 95% CI, 0.39–0.97; P = .03) and MI (RR, 0.40; 95% CI, 0.25–0.66; P < .001).
The five trials performing only staged revascularization did not show any significant benefit in either total mortality (RR, 1.02; 95% CI, 0.65–1.62; P = .87) or MI (RR, 1.04; 95% CI, 0.48–1.68; P = .86).
The investigators concluded that, when feasible, complete revascularization with PCI can significantly reduce the combined endpoint of death and MI. Additionally, complete revascularization performed during primary PCI was associated with significant reductions in both total mortality and MI, whereas staged revascularization did not improve these outcomes, reported the investigators JACC: Cardiovascular Interventions.