Culprit-lesion only versus complete multivessel percutaneous intervention in ST-elevation myocardial infarction: A systematic review and meta-analysis of randomized trials

Pedro A. Villablanca, David F. Briceno, Daniele Massera, Ota Hlinomaz, Marissa Lombardo, Anna Bortnick, Mark A. Menegus, Robert T. Pyo, Mario J. Garcia, Farouk Mookadam, Harish Ramakrishna, Jose M. Wiley, Michela Faggioni, George D. Dangas

Research output: Contribution to journalArticle

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Abstract

Background ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel (MV) coronary artery disease (CAD) is associated with poor outcomes. Percutaneous coronary intervention (PCI) of the culprit-lesion only (CLO) as compared with a MV PCI approach to revascularization remains uncertain. Our objective is to gain a better understanding of the efficacy and safety of CLO as compared with MV PCI in patients with STEMI by conducting an updated meta-analysis. Methods A comprehensive search of PubMed, CENTRAL, EMBASE, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar databases of randomized controlled trials (RCTs) was performed. Results Seven RCTs were included, enrolling a total of 2006 patients. We found that there was a significant reduction in major adverse cardiovascular events (MACE) (OR, 0.62; 95% CI, 0.43–0.90), cardiovascular mortality (OR, 0.46; 95% CI, 0.27–0.80), and repeat revascularization (RRV) (OR, 0.39; 95% CI, 0.30–0.51) favoring MV over the CLO approach for patients undergoing primary PCI. The number needed to treat in order to prevent one CV mortality, RRV, or MACE event is 47, 11, and 16 patients, respectively. No differences were observed between MV vs. CLO PCI for subsequent myocardial infarction (OR, 0.74; 95% CI, 0.40–1.39), all-cause mortality (OR, 0.78; 95% CI, 0.53–1.15), non-cardiovascular mortality (OR, 1.35; 95% CI, 0.74–2.48), all-bleeding events (OR, 0.82; 95% CI, 0.40–1.65), contrast-induced nephropathy (OR, 0.72; 95% CI, 0.33–1.54), and stroke (OR, 1.28; 95% CI, 0.47–3.46). Conclusions MV PCI significantly reduces the rate of MACE, CV mortality, and RRV without significant harm as compared to CLO PCI.

Original languageEnglish (US)
Pages (from-to)251-259
Number of pages9
JournalInternational Journal of Cardiology
Volume220
DOIs
StatePublished - Oct 1 2016

Fingerprint

Percutaneous Coronary Intervention
Meta-Analysis
Mortality
Randomized Controlled Trials
Myocardial Infarction
Numbers Needed To Treat
ST Elevation Myocardial Infarction
PubMed
Coronary Artery Disease
Stroke
Databases
Hemorrhage
Safety

Keywords

  • Meta-analysis
  • Multivessel
  • ST-segment elevation myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Culprit-lesion only versus complete multivessel percutaneous intervention in ST-elevation myocardial infarction : A systematic review and meta-analysis of randomized trials. / Villablanca, Pedro A.; Briceno, David F.; Massera, Daniele; Hlinomaz, Ota; Lombardo, Marissa; Bortnick, Anna; Menegus, Mark A.; Pyo, Robert T.; Garcia, Mario J.; Mookadam, Farouk; Ramakrishna, Harish; Wiley, Jose M.; Faggioni, Michela; Dangas, George D.

In: International Journal of Cardiology, Vol. 220, 01.10.2016, p. 251-259.

Research output: Contribution to journalArticle

Villablanca, Pedro A. ; Briceno, David F. ; Massera, Daniele ; Hlinomaz, Ota ; Lombardo, Marissa ; Bortnick, Anna ; Menegus, Mark A. ; Pyo, Robert T. ; Garcia, Mario J. ; Mookadam, Farouk ; Ramakrishna, Harish ; Wiley, Jose M. ; Faggioni, Michela ; Dangas, George D. / Culprit-lesion only versus complete multivessel percutaneous intervention in ST-elevation myocardial infarction : A systematic review and meta-analysis of randomized trials. In: International Journal of Cardiology. 2016 ; Vol. 220. pp. 251-259.
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title = "Culprit-lesion only versus complete multivessel percutaneous intervention in ST-elevation myocardial infarction: A systematic review and meta-analysis of randomized trials",
abstract = "Background ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel (MV) coronary artery disease (CAD) is associated with poor outcomes. Percutaneous coronary intervention (PCI) of the culprit-lesion only (CLO) as compared with a MV PCI approach to revascularization remains uncertain. Our objective is to gain a better understanding of the efficacy and safety of CLO as compared with MV PCI in patients with STEMI by conducting an updated meta-analysis. Methods A comprehensive search of PubMed, CENTRAL, EMBASE, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar databases of randomized controlled trials (RCTs) was performed. Results Seven RCTs were included, enrolling a total of 2006 patients. We found that there was a significant reduction in major adverse cardiovascular events (MACE) (OR, 0.62; 95{\%} CI, 0.43–0.90), cardiovascular mortality (OR, 0.46; 95{\%} CI, 0.27–0.80), and repeat revascularization (RRV) (OR, 0.39; 95{\%} CI, 0.30–0.51) favoring MV over the CLO approach for patients undergoing primary PCI. The number needed to treat in order to prevent one CV mortality, RRV, or MACE event is 47, 11, and 16 patients, respectively. No differences were observed between MV vs. CLO PCI for subsequent myocardial infarction (OR, 0.74; 95{\%} CI, 0.40–1.39), all-cause mortality (OR, 0.78; 95{\%} CI, 0.53–1.15), non-cardiovascular mortality (OR, 1.35; 95{\%} CI, 0.74–2.48), all-bleeding events (OR, 0.82; 95{\%} CI, 0.40–1.65), contrast-induced nephropathy (OR, 0.72; 95{\%} CI, 0.33–1.54), and stroke (OR, 1.28; 95{\%} CI, 0.47–3.46). Conclusions MV PCI significantly reduces the rate of MACE, CV mortality, and RRV without significant harm as compared to CLO PCI.",
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T1 - Culprit-lesion only versus complete multivessel percutaneous intervention in ST-elevation myocardial infarction

T2 - A systematic review and meta-analysis of randomized trials

AU - Villablanca, Pedro A.

AU - Briceno, David F.

AU - Massera, Daniele

AU - Hlinomaz, Ota

AU - Lombardo, Marissa

AU - Bortnick, Anna

AU - Menegus, Mark A.

AU - Pyo, Robert T.

AU - Garcia, Mario J.

AU - Mookadam, Farouk

AU - Ramakrishna, Harish

AU - Wiley, Jose M.

AU - Faggioni, Michela

AU - Dangas, George D.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel (MV) coronary artery disease (CAD) is associated with poor outcomes. Percutaneous coronary intervention (PCI) of the culprit-lesion only (CLO) as compared with a MV PCI approach to revascularization remains uncertain. Our objective is to gain a better understanding of the efficacy and safety of CLO as compared with MV PCI in patients with STEMI by conducting an updated meta-analysis. Methods A comprehensive search of PubMed, CENTRAL, EMBASE, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar databases of randomized controlled trials (RCTs) was performed. Results Seven RCTs were included, enrolling a total of 2006 patients. We found that there was a significant reduction in major adverse cardiovascular events (MACE) (OR, 0.62; 95% CI, 0.43–0.90), cardiovascular mortality (OR, 0.46; 95% CI, 0.27–0.80), and repeat revascularization (RRV) (OR, 0.39; 95% CI, 0.30–0.51) favoring MV over the CLO approach for patients undergoing primary PCI. The number needed to treat in order to prevent one CV mortality, RRV, or MACE event is 47, 11, and 16 patients, respectively. No differences were observed between MV vs. CLO PCI for subsequent myocardial infarction (OR, 0.74; 95% CI, 0.40–1.39), all-cause mortality (OR, 0.78; 95% CI, 0.53–1.15), non-cardiovascular mortality (OR, 1.35; 95% CI, 0.74–2.48), all-bleeding events (OR, 0.82; 95% CI, 0.40–1.65), contrast-induced nephropathy (OR, 0.72; 95% CI, 0.33–1.54), and stroke (OR, 1.28; 95% CI, 0.47–3.46). Conclusions MV PCI significantly reduces the rate of MACE, CV mortality, and RRV without significant harm as compared to CLO PCI.

AB - Background ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel (MV) coronary artery disease (CAD) is associated with poor outcomes. Percutaneous coronary intervention (PCI) of the culprit-lesion only (CLO) as compared with a MV PCI approach to revascularization remains uncertain. Our objective is to gain a better understanding of the efficacy and safety of CLO as compared with MV PCI in patients with STEMI by conducting an updated meta-analysis. Methods A comprehensive search of PubMed, CENTRAL, EMBASE, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar databases of randomized controlled trials (RCTs) was performed. Results Seven RCTs were included, enrolling a total of 2006 patients. We found that there was a significant reduction in major adverse cardiovascular events (MACE) (OR, 0.62; 95% CI, 0.43–0.90), cardiovascular mortality (OR, 0.46; 95% CI, 0.27–0.80), and repeat revascularization (RRV) (OR, 0.39; 95% CI, 0.30–0.51) favoring MV over the CLO approach for patients undergoing primary PCI. The number needed to treat in order to prevent one CV mortality, RRV, or MACE event is 47, 11, and 16 patients, respectively. No differences were observed between MV vs. CLO PCI for subsequent myocardial infarction (OR, 0.74; 95% CI, 0.40–1.39), all-cause mortality (OR, 0.78; 95% CI, 0.53–1.15), non-cardiovascular mortality (OR, 1.35; 95% CI, 0.74–2.48), all-bleeding events (OR, 0.82; 95% CI, 0.40–1.65), contrast-induced nephropathy (OR, 0.72; 95% CI, 0.33–1.54), and stroke (OR, 1.28; 95% CI, 0.47–3.46). Conclusions MV PCI significantly reduces the rate of MACE, CV mortality, and RRV without significant harm as compared to CLO PCI.

KW - Meta-analysis

KW - Multivessel

KW - ST-segment elevation myocardial infarction

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