Culprit vessel only versus multivessel percutaneous coronary intervention in patients presenting with ST-segment elevation myocardial infarction and multivessel disease

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Abstract

Background: The best strategy for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD), who underwent primary percutaneous coronary intervention (PCI) in the acute phase, is not well established. Objectives: Our goal was to conduct a meta-analysis comparing culprit vessel only percutaneous coronary intervention (culprit PCI) with multivessel percutaneous coronary intervention (MV-PCI) for treatment of patients with STEMI and MVD. Methods: Pubmed, Elsevier, Embase, and China National Knowledge Infrastructure (CNKI) databases were systematically searched for randomized and nonrandomized studies comparing culprit PCI and MV-PCI strategies during the index procedure. A meta-analysis was performed using Review Manager 5.1 (Cochrane Center, Denmark). Results: Four randomized and fourteen nonrandomized studies involving 39,390 patients were included. MV-PCI strategy is associated with an increased short-term mortality (OR: 0.50, 95% CI: 0.32 to 0.77, p = 0.002), long-term mortality (OR: 0.52, 95% CI: 0.36 to 0.74, p<0.001), and risk of renal dysfunction (OR: 0.77, 95% CI: 0.61 to 0.97, p = 0.03) compared with culprit PCI strategy, while it reduced the incidence of revascularization (OR: 2.65, 95% CI: 1.80 to 3.90, p<0.001). Conclusions: This meta-analysis supports current guidelines which indicate that the non-culprit vessel should not be treated during the index procedure. © 2014 Zhang et al.

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Zhang, D., Song, X., Lv, S., Yuan, F., Xu, F., Zhang, M., … Yan, S. (2014). Culprit vessel only versus multivessel percutaneous coronary intervention in patients presenting with ST-segment elevation myocardial infarction and multivessel disease. PLoS ONE, 9(3). https://doi.org/10.1371/journal.pone.0092316

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