Survival After Varying Revascularization Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

• Published in: JACC. Cardiovascular interventions Vol. 9; no. 17; pp. 1765 - 1776
• Main Authors: Tarantini, Giuseppe, MD, PhD, D’Amico, Gianpiero, MD, Brener, Sorin J., MD, Tellaroli, Paola, MSc, PhD, Basile, Marco, MD, Schiavo, Alessandro, MD, Mojoli, Marco, MD, Fraccaro, Chiara, MD, PhD, Marchese, Alfredo, MD, Musumeci, Giuseppe, MD, Stone, Gregg W., MD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 12.09.2016
• Subjects: Cardiovascular; infarct-related artery; multivessel disease; percutaneous coronary intervention; revascularization; ST-segment elevation myocardial infarction; staged; coronary artery disease; revascularization; multivessel disease; CAD; myocardial infarction; multivessel; DM; MV; diabetes mellitus; staged; infarct-related artery; percutaneous coronary intervention; PCI; STEMI; IRA; ST-segment elevation myocardial infarction; MI
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2016.06.012

Abstract Objectives The authors conducted a systematic pairwise and network meta-analysis to assess optimal treatment strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MV-CAD) undergoing primary percutaneous coronary intervention (PCI). Background Patients with STEMI and MV-CAD have a worse prognosis than those with single-vessel CAD. The optimal revascularization strategy for these patients is uncertain. Methods Studies of revascularization strategies for MV-CAD in STEMI patients undergoing primary PCI published between 2001 and 2015 were identified using an electronic search. Pairwise and network meta-analyses were performed for 3 PCI strategies in prospective and retrospective studies: 1) infarct-related artery (IRA)-only PCI; 2) single procedure MV-PCI; and 3) staged MV-PCI. Information on study design, inclusion and exclusion criteria, and clinical outcomes was extracted. The outcomes of interest were short-term and long-term mortality. Results Thirty-two studies (13 prospective and 19 retrospective) with 54,148 patients (IRA-only PCI [n = 42,112], single procedure MV-PCI [n = 8,138], and staged MV-PCI [n = 3,898]) were included in the analysis. Pairwise meta-analyses showed that staged MV-PCI was associated with lower short-term and long-term mortality compared with both IRA-only PCI and single stage MV-PCI, whereas IRA-only PCI was associated with lower mortality compared with single stage MV-PCI. Staged MV-PCI was also associated consistently with improved survival in network analyses. Conclusions The present systematic review and meta-analysis supports the hypothesis that in patients with MV-CAD presenting with STEMI undergoing primary PCI, a staged multivessel revascularization strategy may improve early and late survival.